UC-NRLF 


ED    ID fl 


FOR    INTERNATIONAL    PEACE 
TERCOURSE  AND  EDUCATION 

PUBLICATION  NO,  II 


HYGIENE  and  WAR 

Suggestions  for  Makers  of  Text-books  and  for  Use  in  Schools 


BY 

GEORGE  ELLIS  JONES,  Pu.D 

Assistant  Professor  of  Educational  Psychology 
University  of  Pittsburgh 

WITH  AN  INTRODUCTION  BY 

WILLIAM  HENRY  BURNHAM,  Pn,D, 

Professor  of  Pedagogy  and  School  Hygiene 

«,  Clark  University 


EDITED  BY 

PAUL  MONROE,  Pn.D,,  LL,D, 


Published  by  the  Endowment 

Washington,  D.  C. 

1917 


•\r 


CARNEGIE    ENDOWMENT   FOR    INTERNATIONAL    PEACE 
DIVISION  OF  INTERCOURSE  AND  EDUCATION 

PUBLICATION  NO.  II 


HYGIENE  and  WAR 

Suggestions  for  Makers  of  Text-books  and  for  Use  in  Schools 
BY 

GEORGE  ELLIS  JONES,  PH.D. 

Assistant  Professor  of  Educational  Psychology 
University  of  Pittsburgh 

WITH  AN  INTRODUCTION  BY 

WILLIAM  HENRY  BURNHAM,  PH.D. 

Professor  of  Pedagogy  and  School  Hygiene 
Clark  University 


EDITED  BY 

PAUL  MONROE,  PH.D.,  LL.D. 


Published  by  the  Endowment 

Washington,  D.  C. 

1917 


UNIVERSITY  PRINTING  OFFICE 
COLUMBIA  UNIVERSITY 


FOREWORD 

The  chief  purpose  of  this  and  related  pamphlets  in  literature, 
arithmetic  and  geography  is  to  present  to  the  school  children 
of  the  United  States  materials  showing  the  futility  and  burden 
of  militarism  and  the  destructiveness  and  barbarism  of  modern 
war,  or  materials  relating  to  the  heroism  and  patriotic  services 
of  deeds  of  everyday  life.  The  accomplishment  of  this  purpose 
is  sought  through  two  means: 

First,  it  is  hoped  to  interest  text-book  writers  in  the  feasi- 
bility and  desirability  of  incorporating  some  of  the  materials 
published  in  this  pamphlet,  or  materials  of  a  similar  nature 
suggested  by  them,  in  the  text-books  to  be  written  for  our 
schools. 

Second,  awaiting  such  more  or  less  remote  results,  it  is 
sought  to  place  in  the  hands  of  the  teachers  of  the  special 
subjects  in  the  schools  the  appropriate  pamphlets  that  they 
may  use  them  in  their  regular  class  instruction.  There  is  no 
desire  to  deny  the  heroism  called  for  by  war  or  the  necessity  of 
the  patriotism  and  the  sacrifices  demanded  by  war.  Yet  it  is 
hoped  to  develop  a  broad  and  tolerant  conception  of  patriot- 
ism and  higher  idealism  through  the  incorporation  of  the 
matter  suggested  into  the  materials  of  instruction. 

The  materials  of  this  pamphlet  were  collected  a  year  or 
more  ago,  so  that  much  of  the  information  resulting  from 
the  experiences  of  the  present  war  was  not  available.  Since 
publication,  our  own  country  has  become  involved  in  the 
world-wide  struggle;  but  as  the  pamphlet  contains  so  much 
material  that  is  of  value  in  time  of  war,  its  circulation  has 
not  been  withheld. 


REQUESTS  FOR  ADDITIONAL  COPIES  OR  FOR  FURTHER 

INFORMATION  MAY  BE  ADDRESSED  TO 

DIVISION  OF  INTERCOURSE  AND  EDUCATION 

CARNEGIE  ENDOWMENT  FOR  INTERNATIONAL  PEACE 

407  WEST  II7TH  STREET 

NEW  YORK  CITY 


381171 


AN   INTRODUCTORY  STATEMENT 
By  WILLIAM  H.  BURNHAM 

Clark  University 

The  Effects  of  War  on  Hygiene.  5 

1.  An  emphasis  on  hygiene.  5 

2.  Hygienic  discoveries.  6 

3.  A  setback  of  man's  perennial  conflict  with  disease.  7 

The  direct  loss  to  hygiene.  1 1 

Hygiene  when  the  war  ends.  12 

Hygiene  and  the  Larger  Problems  of  the  War.  14 

Hygienic  Training  as  an  Essential  of  Preparedness.  16 

Conclusion.  26 

HYGIENE  AND  WAR 
By  GEORGE  E.  JONES 

University  of  Pittsburgh 

I.    Introduction.  31 

Special  hygienic  points.  General  conclusions.  Fundamentals 
of  preparedness.  Limitation  of  scientific  investigation  by  war. 
Inadequacy  of  war  in  attaining  results  at  which  it  aims.  Im- 
portance of  hygiene  prior  to  and  during  the  war.  Recency  of 
emphasis  upon  hygiene  by  army  men.  The  field  involved  in 
military  hygiene. 

II.  Destructiveness  of  War  through  Diseases  and  Wounds.  40 
Types  of  Diseases.  Deficiency  diseases  (beri-beri,  scurvy).  In- 
fectious diseases.  Diseases  to  be  expected  in  wars  such  as 
present  European  conflict.  Typhoid  and  the  principles  of  in- 
oculation. Poison  gas.  Air  sickness.  Gun  deafness.  Cholera 
and  plague.  Dysentery  and  diarrhoea.  Tetanus.  Mental 
troubles.  Venereal  diseases.  Frost  bite  or  Trench  feet  (so- 
called).  Protection  trom  cold. 

Vermin.  Their  influence  in  spreading  disease  and  upon  the  gen- 
eral health.  Methods  of  protection. 

[i] 


HYGIENE     AND     WAR 

Wounds.  General  statistics.  Trial-and-error  method.  Fatalities. 
Dum-dum.  Wounds  vs.  disease.  Morale  and  self-aid.  Pecu- 
liar manifestations.  Air  darts.  New  methods. 

The  Role  of  Diseases  in  War.  Data  from  general  sources  (numer- 
ical). Losses  of  the  United  States  in  the  Civil  War. 

III.  Economic  Results  of  War.  80 

Burden  upon  the  whole  people — economic,  social,  and  moral.  Cost 
of  the  Balkan  war.  Cost  of  the  Spanish-American  war.  Who 
pays  the  cost? 

IV.  The  Civilian  Population  and  War.  94 
Suffering  of  Non-combatants.    Loss  not  confined  to  armies.    Data 

inadequate.  Effect  of  general  sanitary  conditions.  Tendency 
to  neglect  home  in  order  to  provide  for  war;  necessity  of 
avoiding  this  pointed  out  by  German  hygienists. 

Food.  Limitation  of  kind  and  quantity  ultimately  necessary 
as  shown  by  the  kind  and  amount  needed  for  soldiers  and 
civilians.  Discussion  of  manipulation  of  food  supply  to  meet 
exigencies — kind,  cooking.  Civilian  food  in  war  time  (special 
data  with  reference  to  England  and  Germany).  Food  and 
fatigue.  School  feeding.  Warbread.  General  facts  indicat- 
ing tasks  imposed  upon  the  people  at  home  by  war. 

Effects  upon  Morale  and  Morals.  Data  with  reference  to  non- 
combatants  in  Balkan  wars.  Data  showing  inadequacy  of 
war  as  a  promoter  of  ethics. 

V.   The  Elimination  of  the  Fit.  132 

Recruits.  The  type  of  men  selected;  general  points  considered. 
Age,  height,  weight,  chest.  Deformities.  General  health. 
Teeth.  Clothing — kinds,  making,  care  of.  Equipment. 

Eugenics  and  War.  War  as  a  maker  of  homes.  Necessity  for 
anticipating  the  future.  Disgenic  effects.  War  not  a  natural 
agent  in  selection.  Some  probable  benefits.  War  babies.  War 
and  sexual  life.  Influence  of  war  on  the  race — general  facts 
and  data  from  the  War  of  the  Rebellion  showing  the  loss  of 
the  most  fit. 

VI.    Benefits  to  the  General  Population.  155 

a.  if  it  should  follow  as  efficiently  as  do  soldiers,  the  hygienic 
training  and  care  of  the  latter. 

b.  if  the  efforts  now  expended  upon  soldiers  alone  were  ex- 
pended upon  the  general  population. 

[2] 


HYGIENE     AND     WAR 

The  Function  of  War  in  Hygiene.  Character  of  the  soldier's 
training — personal  hygiene,  bathing,  care  of  teeth,  care  of 
clothing,  diet  and  eating.  Other  factors  considered.  Physi- 
cal training.  First  aid.  Swimming. 

The  Medical  Corps.  History,  organization.  Contributions  to 
sanitation — products  of  peace,  not  possible  during  war.  Hero- 
ism of  men  in  this  service.  Yellow  fever  conquered.  Cholera 
controlled  in  India.  Panama  Canal  made  possible.  Facts  of 
camp,  battlefield,  and  barracks  sanitation  which  should 
function  in  many  phases  of  municipal  and  rural  life. 

Water  Supply.  Selection  and  protection.  Amount  needed. 
Purification. 

Alcohol  and  Tobacco  for  the  Soldier.    Facts  which  should  be  known 
and  observed  by  civilians.     Some  inferences  from  data  pre-    - 
sented. 

Bibliography 

Authors  181 

Topics  196 


[3] 


HYGIENE  AND  WAR 

AN  INTRODUCTORY  STATEMENT 

By  WILLIAM  H.  BURNHAM 

Clark  University,  Worcester,  Mass. 

The  effects  of  war  upon  hygiene  are  as  follows : 

1.  War  emphasizes  certain  essential  hygienic  precautions. 

2.  War   contributes   to   hygiene   the   discovery   of   certain 
important  sanitary  measures,  methods,  and  devices. 

3.  On  the  other  hand,  war  causes  a  serious  setback  to  the 
battle  which  hygiene  is  constantly  waging  against  the  enemies 
of  man's  health. 

Much  evidence  upon  each  of  these  points  has  been  furnished 
by  the  present  great  war.  The  data  available  are  inadequate; 
but  it  is  reasonably  clear  from  the  facts  obtainable  that  the 
interference  with  general  hygiene  resulting  from  the  war  far 
outweighs  the  direct  contribution  furnished.  Possibly  after 
peace  is  established,  however,  the  need  of  hygienic  measures 
will  be  demonstrated  so  clearly  that  a  great  advance  may  occur, 
in  part  compensating  for  the  terrible  setback  due  to  the  war. 
The  three  points  mentioned  above  may  well  be  especially 
emphasized.  Dr.  Jones  has  studied  the  data  bearing  upon 
each,  and  attempted  to  present  the  facts. 

THE   EMPHASIS   ON   HYGIENE 

The  war  puts  a  tremendous  emphasis  on  the  need  of  hygiene ; 
and  military  hygiene  offers  many  lessons  to  general  hygiene. 
Modern  study  has  shown  that  those  trained  in  habits  of  health 
and  cleanliness  have  a  great  advantage  in  war.  Victory  does 
not  lie  now,  as  largely  in  the  past,  with  pestilence,  but  with 
soldiers  trained  in  mental  and  physical  hygiene.  It  appears 
that  the  requirements  for  a  good  recruit  and  a  good  soldier  are 
much  the  same  as  the  requirements  for  business  occupations, 

[si 


HYGIENE     AND     WAR 

that  the  same  elements  largely  have  to  be  considered  in  the 
choice  of  the  soldier  as  in  the  selection  of  a  workman ;  and  we 
may  add  that  good  teeth,  good  digestion,  cleanliness,  and 
habits  of  healthful  activity  are  alike  valuable  for  the  soldier 
and  for  the  artisan. 

Again,  a  vast  war  literature  bearing  more  or  less  upon 
health  has  appeared;  and  thus,  while  the  conditions  brought 
about  by  war  have  been  a  serious  setback  to  hygiene,  they 
have  contributed  on  the  other  hand,  a  certain  emphasis  on 
the  need  of  hygiene. 

HYGIENIC  DISCOVERIES 

Some  important  contributions  to  hygiene  have  resulted  from 
the  war.  For  example,  attention  has  been  given  to  food  and 
the  formulation  of  rules  in  regard  to  simple  and  nutritious  and 
economic  diet.  This  has  included  rules  not  merely  in  regard 
to  food,  but  also  in  regard  to  the  use  of  beverages;  and  impor- 
tant reforms  in  the  use  of  alcoholic  drinks  have  been  advocated 
and  begun. 

It  is  customary  to  point  to  the  fact  that  a  war  contributes 
largely  to  hygiene  because  of  the  discoveries  made  in  regard  to 
hygienic  methods  and  devices;  and  it  may  be  pointed  out  that 
had  it  not  been  for  war  we  might  not  yet  have  discovered 
certain  important  hygienic  truths,  possibly  the  value  of  some 
of  the  best  disinfectants,  and  the  like.  Moreover,  the  great 
contributions  to  hygiene  resulting  from  the  necessities  of  camp 
life  are  not  at  all  to  be  underestimated.  But  however  valuable 
such  results  have  been,  science  does  not  need  the  crude  experi- 
ments of  war  to  determine  hygienic  truth  at  present;  for  the 
laboratory  with  controlled  experiments  gives  far  better  oppor- 
tunities for  hygienic  research. 

Further,  it  appears  that  the  school  hygiene  developed  in  the 
last  fifty  years  is  now  receiving  its  crucial  test  and  proving  its 
worth.  The  excellent  condition  of  the  men  in  the  field  is  due 
largely  to  their  school  training.  War  is  proving  that  hygiene 
taught  and  practised  in  years  of  peace  shows  its  effect  in  time 
of  war;  and  further,  the  war  proves,  contrary  to  the  opinion 

[6] 


HYGIENE     AND     WAR 

of  some,  that  the  youth  of  today  are  not  weak  and  effeminate, 
although  perhaps  they  are  more  sensitive  than  those  of  earlier 
generations. 

Thus  war  puts  an  emphasis  on  the  need  of  hygiene ;  but  peace 
is  necessary  to  develop  the  art  of  hygiene.  The  stress  of  war 
suggests  certain  hygienic  measures,  but  peace  is  necessary  to 
give  them  general  application.  War  sometimes  shows  the 
importance  of  changes  in  modes  of  life,  but  peace  again  is 
necessary  to  habituate  people  to  these  changes. 

MAN'S   PERENNIAL   CONFLICT  WITH   DISEASE 
AND   ITS    SETBACK   BY   THE   WAR 

Perhaps  this  last  point,  the  interference  of  war  with  general 
hygiene,  is  the  one  most  likely  to  be  ignored  or  underestimated, 
because  few  people  realize  the  significance  of  the  war  continu- 
ally waged  by  hygiene  against  the  enemies  that  threaten  the 
health  of  human  beings.  Mr.  Ealand,  in  his  new  book, 
Insects  and  Man,  has  described  this  interestingly  and  vividly, 
and  has  shown  in  much  detail  the  conditions  of  the  warfare 
on  this  planet  between  man  and  his  enemies  in  the  insect 
world.  Mr.  Ealand  goes  so  far  as  to  maintain  that  the  outcome 
of  this  great  war  between  man  and  the  arthropod  is  nearly  as 
much  in  doubt  as  the  result  of  the  present  European  conflict; 
and  he  even  suggests  that  it  is  almost  a  toss-up  whether  man  or 
insect  will  ultimately  have  possession  of  this  planet.  Whether 
or  not  he  exaggerates,  there  can  be  no  question  about  the 
seriousness  of  the  situation.  The  vital  importance  to  mankind 
of  this  great  hygienic  warfare  may  be  shown  by  noting  some  of 
the  facts  presented  by  Mr.  Ealand.  I  shall  quote  from  Mr. 
Johnston's  striking  summary *  of  this  book  as  well  as  from  the 
original. 

Mr.  Ealand  has  shown  the  immeasurable  damage  done  by 
insects,  especially  in  conveying  disease,  and  the  necessity  for  the 
whole  human  race  to  engage  in  the  great  warfare  against  these 
common  enemies.  This  is  what  Mr.  Johnston  calls  the  next 
war,  although  it  is  really  a  war  already  waged  for  many  years. 

1  In  ipth  Century  and  After,  July,  1915. 

[7] 


HYGIENE     AND     WAR 

A  war  to  be  waged,  not  between  man  and  man,  but  between  Man  on 
the  one  side  and  the  Arthropod  on  the  other,  a  war  to  be  fought  to  the 
finish  to  decide  which  of  the  two  forms  of  life,  this  highly  developed  verte- 
brate, or  these  malignly  evolved  invertebrates,  is  to  govern  our  planet. 
Is  the  lord  of  this  earth  some  day  to  be  a  monstrous  ant  or  bug,  a  wasp  or 
a  midge,  a  scale-insect  or  a  tick — or  is  it  to  be  this  godlike  mammal  who 
walks  erect  and  can  see  the  stars  and  weigh  the  suns  and  planets,  who  is 
already  in  touch  with  the  supra-mundane  universe? 

The  Sporozoa  and  Flagellata — micro-organisms  at  the  base 
of  the  animal  kingdom — and  the  Schizomycetes — vegetable 
germs  of  single  cells  commonly  called  bacteria — are  the  direct 
causes  of  nearly  all  the  diseases  which  afflict  humanity.  And 
the  elimination  of  these  depends  upon  the  elimination  of  the 
insect  carriers  that  disseminate  disease  by  introducing  the 
germs  into  the  skin,  the  stomach,  or  the  veins  of  man  and  other 
animals,  and  the  tissues  of  plants. 

It  should  be  remembered  that  recent  investigations  have 
shown  that  without  the  Anopheles  mosquito,  there  is  no 
malaria;  without  the  Stygomia  mosquito,  there  is  no  yellow 
fever;  without  the  Tse-tse  fly,  there  is  no  sleeping  sickness; 
and  without  ticks,  fleas,  and  the  like,  probably  the  plague  and 
several  other  diseases  would  be  exterminated.  Without  the 
housefly,  typhoid  fever  would  be  easily  controlled;  and  if  it 
were  possible  to  destroy  the  harmful  bugs,  scale-insects,  aphids, 
and  the  like,  the  plant  food  of  the  world  would  be  enormously 
increased. 

As  Mr.  Ealand  points  out  we  have  certain  allies  also  in  the 
animal  world,  especially  the  birds,  and  next  to  the  birds, 
lizards  and  fresh  water  fish.  Even  among  the  insects  them- 
selves we  have  some  important  allies,  the  various  parasites 
that  attack  and  destroy  other  insects.  Especially  noteworthy 
are  the  little  beetles  called  lady-birds,  or  the  Coccinellidae. 
As  Mr.  Johnston  summarizes  Ealand's  facts: 

There  does  not  seem  to  be  a  'bad'  lady-bird  from  Man's  point  of  view; 
for  the  Coccinellidae  have  apparently  come  into  existence  for  the  purpose 
of  attacking  and  exterminating  the  multiform  caterpillars,  scale-insects, 
aphids,  beetlegrubs  and  frog-hoppers  which  devour  our  food  crops,  our 
fruit  and  foliage  trees,  our  tobacco,  and  our  melons.  Each  precious  plant 

[8] 


HYGIENE     AND     WAR 

or  tree  in  this  category  seems  to  have  its  tutelary  saint  among  the  Coccinel- 
lidae,  and  one  can  imagine  in  the  coming  age  of  knowledge  (the  millennium 
which  shall  follow  the  present  War)  grateful  cultivators  erecting  shrines 
and  tablets  in  honor  of  this  or  that  lady-bird  protector  of  their  crops.  The 
Beetle  order — besides  the  Coccinellidae — contributes  another  family  to 
Man's  allies;  the  Carabidae  or  ground  beetles,  nearly  all  of  which  are  car- 
nivorous and  addicted  to  attacking  and  devouring  chiefly  other  insects, 
mainly  in  the  larval  stage.  They  even  by  some  extraordinary  instinct 
prefer  the  female  larvae  (in  some  instances),  thus  destroying  with  a  nip  a 
possible  mother  of  thousands.  Many  of  the  Carabids  devour  the  obnoxious 
termites  in  tropical  countries.  But  the  genus  Calosoma,  which  happens  to 
be  beautiful  as  well  as  right-minded,  is  worthy  of  international  recognition 
as  the  inveterate  enemy  of  the  gipsy  moth,  that  ghastly  plague  of  the 
Eastern  United  States — a  destroyer  of  noble  trees  and  apple  orchards. 

Many  of  the  other  insects  are  man's  allies,  e.g.,  dragon-flies, 
ant-lions,  and  many  wasps;  and  even  a  few  of  the  ticks  are 
helpful,  as  well  as  certain  fungi  and  bacilli  which  can  be 
used  as  insecticides.  But  the  majority  of  insects  and  ticks  are 
in  direct  conflict  with  the  interests  of  mankind. 

Mr.  Ealand  speaks  of  the  thousand  and  one  ways  in  which 
the  activities  of  man  and  insects  harmonize  and  of  the  mutual 
benefit  that  they  are  to  each  other,  and  he  also  speaks  of  the 
many  ways  in  which  a  war  to  the  death  for  supremacy  occurs. 
In  part  he  says: 

It  is  fortunate  for  man  that  the  insect  world  is  a  house  divided  against 
itself;  except  for  this  check  the  human  race  would  be  extinct  in  five  or  six 
years.  The  fecundity  of  many  insects  is  enormous;  Huxley  estimated  that, 
mishaps  apart,  a  single  green  fly  would,  in  ten  generations,  produce  a  mass 
of  organic  matter  equivalent  to  five  hundred  million  human  beings,  or 
as  many  as  the  whole  population  of  the  Chinese  empire.  From  the  earliest 
times  man  has  suffered  from  insect  damage  to  his  crops,  his  live  stock,  and 
himself.  Locust  plagues,  rivalling  those  of  Egypt,  have  come  to  man  from 
time  to  time.  Pliny  mentions  them;  they  visited  Ukraine  in  1645,  and 
America  at  the  close  of  the  Civil  War;  a  vast  swarm  two  thousand  miles  in 
extent  crossed  the  Red  Sea  in  1899,  and  eight  years  previously  one  thousand 
three  hundred  tons  of  locust  eggs  were  destroyed  in  Cyprus  alone.  But  this 
is  not  all;  the  United  States  suffers  damage  to  the  extent  of  $40,000,000 
owing  to  the  depredations  of  the  Hessian  fly;  the  cotton-boll  weevil  causes 
an  annual  loss  of  $30,000,000;  the  codling  moth  $15,000,000,  and  the  chinch 
bug  $7,000,000;  add  to  this  the  damage  done  by  gipsy  moths  and  brown-tail 
moths,  and  the  San  Jose  scale,  to  say  nothing  of  a  host  of  minor  pests,  and 
the  total  assumes  alarming  proportions. 

[9] 


HYGIENE     AND     WAR 

Professor  Arthur  Shipley  of  Cambridge,  in  a  paper  before 
the  Royal  Society  of  Arts,  has  presented  a  similar  view,  point- 
ing out  that  insects  have  helped  to  destroy  famous  civilizations 
and  that  they  constitute  a  real  peril  today  to  the  armies  oper- 
ating in  Asia  and  Africa.  These  insects  which  affect  man  in 
times  of  war  are  those  which  affect  him  also  in  times  of  peace, 
but  in  war  time  their  effects  are  likely  to  be  more  violent  and 
more  persistent. 

Of  the  present  war  Mr.  Johnston  writes: 

The  frightfully  damaging  part  that  can  be  played  by  insects  in  all  the 
crises  of  humanity,  in  all  extraordinary  conditions  of  life,  is  brought  home 
to  us  by  the  present  war.  The  drawing  together  of  men  from  the  humblest 
habitations  in  the  kingdom  has  caused  the  comfortable-living  amongst  the 
middle  and  the  upper  classes  to  realize  our  national  crime  in  having  so  long 
tolerated  the  shocking  housing  conditions  of  the  mass  of  our  people.  The 
decently  clad,  decently  brought  up  clerk,  who  perhaps  has  never  given  a 
thought  to  the  life  of  the  agricultural  laborer  or  the  mill  hand,  realizes  when 
packed  into  a  tent  with  eleven  other  men,  who  have  gallantly  left  the  plough 
or  the  factory  to  risk  their  lives  for  the  upholding  of  their  country's  interests, 
that  the  picturesque  country  cottage  or  the  vile  city  slum  still  tolerated  by 
our  farmers  and  our  smug  city  fathers,  swarms  with  bugs  and  lice  and 
fleas;  that  life  under  these  conditions  (often  with  a  wretched  water-supply 
and  no  means  of  maintaining  proper  personal  cleanliness)  results  in  able- 
bodied  men  and  women  being  carriers  of  bugs,  fleas  and  lice,  either  on  their 
persons  or  in  their  garments  or  belongings.  Immediately  following  this 
discovery  comes  something  far  worse  than  sleepless  nights  from  the  attacks 
of  vermin,  comes  illness — perhaps  death — from  insect-conveyed  diseases. 
This  misery  of  vermin  will  at  any  rate  stand  out  prominently  among  the 
many  forms  of  wretchedness  caused  by  the  present  War. 

The  indirect  loss  to  hygiene  can  hardly  be  overestimated. 
The  war  has  turned  us  aside  from  the  warfare  against  our  insect 
enemies.  In  Europe,  at  least,  forces  that  should  be  united  in 
fighting  the  common  enemy  are  now  divided,  fighting  against 
each  other.  The  most  stupendous  loss  to  hygiene  has  come  in 
this  indirect  way.  The  enemy,  taking  advantage  of  the 
divided  forces  opposed  to  it,  has  attacked  mankind  all  along 
the  line  of  the  war  in  Europe.  In  meeting  these  attacks  some 
new  and  valuable  methods  have  been  developed,  but  the  com- 
mon enemy  has  gained  ground  enormously  as  indicated  by 
the  records  we  have. 

[10] 


HYGIENE     AND     WAR 

Another  way  in  which  the  war  is  likely  seriously  to  hinder 
the  warfare  against  disease  is  that  it  is  hard  on  the  insect- 
destroying  birds.  Not  only  do  many  of  the  soldiers  in  their 
leisure  hours  shoot  the  birds,  but  the  continual  firing  of 
artillery  and  the  like  is  particularly  bad,  for  it  destroys 
large  numbers  and  frightens  away  others.  The  details  of 
this  have  not  come  to  hand,  but  clearly  it  is  a  serious  evil. 

However  great  the  emphasis  that  war  places  upon  the  need 
of  hygiene,  the  actual  development  of  hygiene  requires  a  time 
of  peace.  The  progress  even  of  military  hygiene,  although 
stimulated  by  war,  has  been  possible  only  in  times  of  peace. 
The  study  of  typhus  fever,  typhoid,  and  so  on,  was  made  not 
in  war  time  but  in  peace;  yellow  fever  was  investigated,  con- 
quered, and  driven  out  of  Havana,  New  Orleans,  and  Panama 
during  a  period  of  peace ;  and  likewise  the  conquest  of  malaria 
and  other  diseases  has  been  a  victory  of  peace  rather  than  of 
war.  Peace  is  necessary  also  because  the  warfare  against  our 
insect  enemies,  as  has  been  shown  by  the  reports  of  Col. 
Gorgas  from  Panama,  must  be  continuous.  Apropos  of  this 
it  is  said : 

The  battle  with  nature  is  unending,  and  the  slightest  relaxation  means 
reversion  .  .  .  Special  and  exceptional  problems  are  being  constantly 
presented,  due  in  many  instances  to  the  engineering  work  connected  with 
canal  construction.  Swamps  of  large  area  are  sometimes  unavoidably 
created,  and  before  drainage  can  be  effected,  breeding  of  Anopheles  has 
assumed  formidable  proportions.  .  .  .  The  great  Gatun  lake,  with  its 
approximately  two  hundred  square  miles  of  area  and  hundreds  of  miles  of 
rugged  shore  line,  bids  fair  to  offer  many  problems  as  its  level  continues  to 
rise.  In  the  sheltered  bays  and  indentations  of  its  shore  line  aquatic  vege- 
tation riots  and,  as  the  waters  inundate  the  tropical  forest,  a  condition  is 
created  ideal  for  the  most  prolific  breeding  of  Anopheles  and  other  mosqui- 
toes— a  tangle  of  living  and  dead  vegetation,  with  floating  debris  from  the 
dying  trees,  among  which  water  plants  flourish.1 

The  Direct  Loss  to  Hygiene. — Something  should  be  said,  too, 
about  the  more  direct  hygienic  loss  from  war.  Not  only  has 
the  present  war  handicapped  us  in  our  warfare  against  disease, 
but  there  has  been  a  very  direct  loss;  in  the  first  place,  because 

1  Cited  by  Ealand,  p.  91. 

fir] 


HYGIENE     AND     WAR 

in  the  stress  of  necessity  soldiers  and  the  citizens  in  general 
have  felt  that  they  could  not  take  the  time  for  many  hygienic 
measures;  in  the  second  place,  because  the  money  and  equip- 
ment that  in  times  of  peace  would  be  devoted  to  hygienic 
investigation  and  sanitary  improvement  have  been  utilized 
for  military  purposes;  and  in  a  hundred  more  concrete  ways 
there  has  likewise  been  a  serious  direct  loss. 

Again,  so  many  physicians  and  nurses  have  been  called  to 
the  front  that  the  medical  care  and  sanitation  of  schools  and 
the  like  are  being  neglected,  although  it  is  more  important  than 
usual  that  proper  hygiene  be  practised  at  home. 

Finally,  the  facts  show  the  fallacy  of  those  who  deem  war 
a  helpful  factor  in  biological  evolution  because  it  is  supposed 
to  ensure  the  survival  of  the  fittest.  Many  rash  and  foolish 
statements  have  been  made  in  regard  to  the  effect  of  war  on 
the  human  race.  Even  the  advocates  of  eugenics  have  not 
been  free  from  error.  While  noting  some  of  these  errors,  our 
study  has  shown  the  serious  evil  that  results  from  war  in  the 
destruction  of  the  fittest  among  the  population,  both  men  and 
women. 

The  data  available  indicates  that  the  entire  population  of 
countries  at  war  suffer.  And  Dr.  Jones  concludes  that  the 
number  of  deaths  due  to  worry,  overwork,  deprivations,  and 
the  like,  among  the  women,  children,  and  others  left  at  home, 
approximates  that  of  the  army. 

Hygiene  When  the  War  Ends. — Again,  the  progress  of 
hygiene  is  retarded  by  war,  because  the  vast  number  of  cripples 
and  invalids  make  the  problems  of  hygiene  much  more  difficult. 
And  it  is  now  recognized  by  physicians  and  hygienists  that 
special  preparation  must  be  made  for  avoiding  the  evils  that 
will  follow  as  a  result  of  the  war.  The  Canadian  Public 
Health  Association  and  the  American  Association  for  Public 
Health  have  considered  this  subject  in  their  recent  meetings. 
And,  as  President  Jordan  has  pointed  out,  the  lands  engaged 
in  war  must,  if  they  are  to  recover  from  the  struggle,  take 
better  care  of  their  people  in  the  future  than  they  have  been 
wont  to  in  the  past. 

[12] 


HYGIENE     AND     WAR 

The  health  departments  after  the  war  must  take  up  new 
lines  of  activity  and  do  more  and  better  work.  It  has  been 
pointed  out  that  one  result  of  every  war  in  the  past  has  been 
the  increased  number  of  unfit  houses,  and  the  multiplied 
number  of  people  living  in  such  houses.  The  vast  army  of 
cripples  and  those  disabled  in  different  ways  find  their  way 
after  a  war  into  unsanitary  homes,  because  they  can  be  had 
for  a  low  rent.  It  is  stated  that  when  a  family  has  lived  in  a 
tumble-down  house  for  two  generations  it  would  not  live 
anywhere  else.  Such  a  family  would  not  live  cleanly  and 
hygienically  even  if  placed  in  a  palace.  The  bad  house  and 
the  bad  district  affect  the  mental  and  moral  tone  of  the  people 
when  they  have  been  subjected  to  it  for  more  than  a  genera- 
tion. Thus  it  is  already  recognized  by  the  Canadian  health 
officers  that  the  towns  and  cities  must  try  to  offset  the  effects 
of  the  war  by  preventing  this  bad  housing  after  the  war  is  over. 

It  is  well  to  consider  also  what  will  be  the  effect  on  this 
country  when  the  war  is  over.  We  must  surely  expect  that 
in  Europe  at  least  taxes  will  be  enormously  high.  In  many 
cases  the  burden  will  be  too  great  for  the  people  to  bear. 
Naturally  many  will  emigrate  to  this  country  where  it  is 
possible,  and  we  may  naturally  expect  a  vast  influx  of  immi- 
grants at  that  time.  This  makes  it  doubly  necessary  that 
we  should  take  precautions  that  the  feeble-minded  and  crimi- 
nal may  be  kept  from  coming  to  our  shores,  and  that  proper 
sanitary  measures  may  be  taken  to  keep  out  cases  of  infec- 
tious diseases,  and  the  like. 

One  point  is  of  such  vital  importance  that  it  may  well 
receive  the  attention  of  every  Board  of  Health,  namely,  the 
problem  of  protecting  communities  from  infectious  diseases 
that  will  be  brought  home  by  the  sick  soldiers  at  the  close 
of  the  war.  With  the  large  number  of  immigrants  sure  to 
come  to  this  country,  this  is  a  problem  for  the  United  States 
as  well  as  Europe.  Especially  serious  is  likely  to  be  the 
danger  of  infection  from  venereal  diseases.  One  concrete 
example  must  suffice  as  illustration  of  the  precautions  that 
can  be  taken.  Australia  has  already  passed  a  drastic  act  in 

[13] 


HYGIENE     AND     WAR 

regard  to  venereal  disease,  requiring  compulsory  examination 
and  treatment,  and  providing  severe  penalties  for  failure  to 
comply  with  the  law.1 

HYGIENE  AND  THE  LARGER  PROBLEMS  OF  THE  WAR 

Some  of  the  larger  problems  connected  with  the  war  also 
have  their  hygienic  aspects. 

Years  ago  Professor  James,  ardent  peace  man  though  he 
was,  warned  us  that  a  millennium  of  peace  would  not  breed 
the  fighting  spirit  out  of  our  bones,  and  suggested  a  year  of 
service  in  various  forms  of  drudgery  as  in  part  a  possible 
substitute  for  war.  More  recently  Professor  Cannon  has 
suggested  football,  and  Professor  Patrick,  sport  in  general, 
as  a  substitute  or  prophylactic  against  the  most  brutal  mani- 
festations of  the  warlike  instincts. 

While  we  attempt  to  develop  mutual  understanding  and 
sympathy  as  the  natural  means  of  controlling  the  impulse  to 
war,  mental  hygiene  emphasizes  also  the  advantages  of  such 
means  as  are  suggested  by  James,  Patrick,  and  Cannon.  Any 
permanent  interest  in  peaceful  activities  will  be  helpful. 

As  one  of  the  best  outlets  for  the  so-called  fighting  instinct 
and  a  natural  substitute  for  war,  the  writer  would  suggest 
enlistment  in  the  warfare  against  the  disease-carrying  insects, 
as  well  as  the  greater  development  of  the  hygienic  side  of  the 
soldier's  training. 

While  this  hygienic  warfare  is  not  so  spectacular  and  does 
not  at  first  appeal  so  strongly  to  the  youth  as  military  war- 
fare, it  would  not  be  difficult  for  tactful  teachers  to  stimulate 
an  interest  in  this  conflict.  -'Not  merely  can  the  importance 
and  practical  utility  of  it  all  be  shown  to  the  young,  but  it 
would  even  not  be  without  appeal  to  the  instincts  of  chivalry 
and  romance.  That  it  gives  opportunity  for  protecting  one's 
friends  from  sickness  and  death,  that  it  is  service  of  the  most 
significant  sort  for  women  and  children  and  the  weak  and 
defective,  make  such  warfare  appeal  even  to  the  higher  altru- 
istic instincts. 

i  Jour,  of  Amer.  Med.  Assoc.,  Sept.  2,  1916,  p.  757- 

[14] 


HYGIENE     AND     WAR 

There  is  a  widespread  effort  to  substitute  the  literature  of 
peace — the  history  of  its  victories  and  achievements,  even 
its  hymns — for  the  literature  of  warfare,  which  so  largely 
makes  up  the  historical  and  other  reading  of  children.  All 
this  is  an  excellent  movement;  but  the  advocates  of  peace,  if 
they  would  be  successful,  must  adopt  a  psychological  method. 
There  is  no  question  about  the  interest  that  boys  and  girls 
have  in  the  accounts  of  battles  and  the  zest  of  conflict.  But 
this  is  rooted  in  a  dee'per  and  more  fundamental  impulse,  the 
impulse  to  activity.  Children  and  youth  are  always  inter- 
ested in  vigorous  activity  and  the  mastering  of  difficulties. 
Any  form  of  strenuous  activity,  as  soon  as  associated  with 
healthy  rivalry,  hearty  cooperation,  and  the  romantic  halo 
of  success,  becomes  a  matter  of  intense  interest.  To  develop 
an  interest,  it  is  necessary  only  that  one  act  frequently  on  the 
basis  of  these  fundamental  impulses.  If  the  monotonous 
routine  of  the  soldier's  life,  the  hardships,  the  difficulties,  the 
endless  repetition  of  daily  tasks,  the  inevitable  marching  and 
drilling — 'Boots,  boots,  boots,  moving  up  and  down  again',  as 
Kipling  puts  it — the  ever-necessary  hygienic  precautions,  the 
wearisome  sanitation,  the  occasional  opportunity  to  encounter 
danger,  to  make  personal  sacrifice,  to  come  to  close  quarters 
with  the  stern  realities  of  life — if  all  this  for  the  real  soldier 
has  the  zest  of  interest  and  romance,  it  is  because  the  interest 
is  based  on  the  fundamental  impulse  to  act  and  to  overcome 
difficulties,  and  the  activity  has  acquired  a  halo  of  associa- 
tions connected  with  the  other  individual  and  group  instincts 
mentioned.  The  so-called  fighting  instinct  plays  but  a  minor 
r61e  here. 

The  warfare  against  disease  gives  opportunity  for  appeal 
to  the  same  fundamental  instincts.  If  at  present  such  occupa- 
tion seems  vapid  and  dull,  it  is  because  it  is  judged  from  the 
outside,  where  as  yet  there  is  no  beating  of  drums,  no  manual 
of  drill,  no  organized  hierarchy  of  grades,  no  insignia  of  rank, 
no  official  rewards,  and  the  like.  But  those  who  have  actually 
done  work  of  this  kind,  who  have  actually  engaged  in  this 
warfare  against  disease,  have  found  the  same  or  higher  inter- 

[15] 


HYGIENE     AND     WAR 

ests  and  rewards.  Even  the  incidentals  of  occasional  oppor- 
tunity to  encounter  danger  and  to  use  one's  wits  in  invention 
and  strategy,  as  well  as  opportunities  for  sacrifice  and  devo- 
tion, are  not  lacking.  Those  who  enter  the  service  acquire 
the  interest. 

Moreover,  literature  in  regard  to  man's  warfare  against 
disease  contains  much  material  that  appeals  to  adolescent 
interest.  The  romances  connected  with  the  warfare  against 
malaria,  yellow  fever,  and  the  like,  are  as  thrilling  as  the 
stories  of  battle.  The  victory  over  the  enemy,  the  discovery 
of  the  enemy's  methods  of  warfare,  the  devices  for  overcom- 
ing the  enemy,  the  plans  of  campaign  necessary  for  success 
in  this  warfare,  the  tragedies  that  may  result  from  a  slight 
mistake — the  escape  of  a  prisoner  or  the  like — are  well  nigh 
as  interesting  as  similar  episodes  of  the  warfare  between 
nations  or  between  man  and  man. 

As  a  single  illustration  take  the  old  story  of  the  introduction 
of  the  gipsy  moth  into  the  United  States.  Professor  Trouve- 
lot  of  Harvard  in  1869  was  experimenting  with  the  European 
gipsy  moth.  The  care  of  the  jailor  was  not  equal  to  the  dan- 
gerous character  of  the  enemy  imprisoned.  According  to  the 
story,  an  egg  was  blown  from  his  study  window  or  one  of  the 
caterpillars  escaped  from  his  prison.  Professor  Trouvelot  at 
once  warned  the  public  that  a  dangerous  insect  was  at  large, 
but  his  warning  was  not  heeded.  People  took  little  notice, 
the  insects  were  seldom  seen;  they  increased  at  first  slowly, 
but  in  a  dozen  years  they  had  a  death  grip  on  the  trees  of 
Massachusetts,  and  the  enormous  cost  to  the  state  and  the 
country  from  the  warfare  against  this  insect  is  all  too  well 
known.  It  is  still  devastating  the  trees  of  the  country,  and 
the  fight  against  it  must  still  be  carried  on  for  years  with 
enormous  expense. 

HYGIENIC  TRAINING  AS  AN  ESSENTIAL  OF  PREPAREDNESS 

At  the  present  time  everybody  is  talking  about  prepared- 
ness. The  vital  question  is  what  form  of  preparedness  is 
efficient  and  worth  while.  For  most  of  the  situations  of  life, 

Fi61 


HYGIENE     AND     WAR 

especially  for  most  of  the  crises  of  life,  the  only  preparedness 
of  prime  worth  is  a  moral  preparedness.  This  truth,  valid  for 
the  crises  of  nations  as  well  as  those  of  individuals,  has  received 
noteworthy  illustration  during  the  last  three  years. 

For  instance,  let  us  take  the  case  of  France.  In  1870  France 
was  unprepared  from  both  a  military  and  a  moral  point  of 
view.  The  result  is  well  known.  The  French  were  beaten. 
Then  in  its  humiliation  the  country  organized  its  great  system 
of  modern  education.  Since  that  time  the  schools  have 
attempted  not  only  to  give  an  education  of  scholastic  and 
intellectual  value,  but  to  give  moral  training.  In  place  of 
rivalry  and  individualism  as  goals  they  have  set  up  self- 
emulation  and  the  development  of  the  spirit  of  cooperation. 
This  has  been  carried  to  a  considerable  degree  even  into  the 
details  of  school  life.  For  example,  each  pupil  has  his  cahier 
historique,  a  little  notebook  in  which  all  that  do  well  have  the 
privilege  of  writing  a  lesson  each  month  which  shall  be  a 
record  of  school  progress  and  development.  The  children  are 
told  that  this  little  book  will  be  a  history  of  their  school  life, 
and  that  each  month  they  should  try  to  do  better  than  they 
did  the  preceding.  They  are  directed  also  in  their  school 
work  not  merely  to  think  of  themselves,  but  to  try  to  work 
with  their  fellows.  Thus  has  the  spirit  of  self-emulation  and 
of  cooperation  been  made  the  aim  of  school  training. 

All  this  training  for  forty  years  has  borne  fruit.  In  1914, 
as  in  1870,  France,  although  it  had  a  large  and  well-trained 
army,  was  not  properly  prepared  from  a  military  point  of 
view,  and  the  first  months  of  the  war  had  to  be  devoted  to 
this  work  of  preparation.  In  1870  France  could  not  make 
this  preparation  after  war  began,  and  hence  Paris  was  taken, 
the  French  defeated.  The  reason  that  the  French  were  able 
to  make  preparation  after  the  war  began  in  1914,  able  to 
turn  the  battle  of  the  Marne  and  check  the  invaders,  was 
largely  because  in  this  later  crisis  they  had  a  moral  prepara- 
tion which  was  lacking  in  1870.  One  who  knows  something 
of  the  history  of  French  education  during  the  last  forty  years, 
and  of  the  attempts  that  have  been  made  to  give  moral  train- 

[17] 


HYGIENE     AND     WAR 

ing  in  connection  with  school  work,  can  but  believe  that  a 
large  factor  in  this  moral  preparedness  which  has  enabled  the 
French  successfully  to  check  invasion  and  to  control  them- 
selves so  admirably  as  to  win  the  praise  even  of  their  enemies, 
is  the  influence  of  education  since  they  had  the  good  fortune 
to  be  defeated  in  1870. 

A  somewhat  similar  example  is  furnished  by  the  earlier 
history  of  Germany,  now  unfortunately  too  often  forgotten. 
In  1806-1807,  when  Prussia  was  humiliated  by  Napoleon, 
Fichte  and  the  German  emperor  appealed  to  the  German 
people  telling  them  that  they  must  make  up  in  the  intellectual 
and  spiritual  field  for  what  they  had  lost  in  the  material  world. 
The  Germans  took  this  advice;  and  from  that  time  dates  the 
remarkable  development  of  modern  German  science  and  edu- 
cation. 

The  period  following  a  great  war  is  the  great  opportunity 
of  education  for  the  vanquished  nation.  It  is  often  a  time 
of  misfortune  to  the  victors.  This  was  largely  so  with 
Germany  after  its  victory  over  the  French  in  1870.  It  would 
be  out  of  place  here  to  enter  into  any  discussion  of  the  relative 
merits  of  the  contestants  in  the  present  war;  but  from  an 
educational  point  of  view  it  is  fitting  to  quote  from  a  careful 
observer,  a  German,  an  ardent  lover  of  his  Fatherland,  and  a 
fair-minded  writer — Professor  Francke  of  Harvard — who  points 
out  some  of  the  unfortunate  developments  in  Germany  in 
recent  years. 

Francke  refers  to  the  spirit  of  superciliousness  which  he 
says  has  developed,  especially  during  the  last  twenty-five  years, 
in  the  ruling  classes  of  Germany. 

The  manifestations  of  this  spirit,  he  says,  have  been  many  and  varied. 
In  German  domestic  conditions,  it  has  led  to  the  growth  of  a  capitalistic 
class  as  snobbish  and  overbearing  as  it  is  resourceful  and  intelligent, 
counteracting  by  its  uncompromising  Herrenmoral  the  good  effect  of  the 
wise  and  provident  social  legislation  inaugurated  by  Bismarck.  It  has  led 
to  excesses  of  military  rule  and  to  assertions  of  autocratic  power  which 
have  embittered  German  party  politics  and  have  driven  large  numbers  of 
Liberal  voters  into  the  Socialist  ranks,  as  the  only  party  consistently  and 
unswervingly  upholding  Parliamentary  rights.  In  Germany's  foreign  rela- 

[181 


HYGIENE     AND     WAR 

tions  it  has  led  to  a  policy  which  was  meant  to  be  firm  but  had  an  appear- 
ance of  arrogance  and  aggressiveness  and  easily  aroused  suspicion.  Sus- 
picion of  Germany  led  to  her  isolation.  And  her  isolation  has  finally 
brought  on  the  war.1 

Reverting  to  our  main  point,  in  this  country  it  is  practically 
impossible,  probably  in  every  country  it  is  largely  impossible, 
to  have  adequate  military  preparedness.  As  soon  as  a  dread- 
naught  is  built  it  begins  to  deteriorate.  As  soon  as  a  sub- 
marine is  built  a  better  form  is  invented.  As  soon  as  a  supe- 
rior form  of  armor  is  devised  a  more  powerful  explosive  is 
invented.  And  with  the  enormous  boundary  lines  to  be  de- 
fended in  a  country  like  this,  adequate  preparation  is  impossi- 
ble without  making  a  large  part  of  the  country  a  military 
camp.  No  one  desires  this ;  and  hence  adequate  military  pre- 
paredness is  out  of  the  question. 

The  most  important  essential  in  the  preparedness  of  this 
nation  is  thus  a  moral  preparedness  which  will  enable  the 
people  quickly  to  fit  themselves  for  any  new  situation  or  any 
crisis  when  it  arises.  Moral  preparedness  is  necessary  for  peace 
as  well  as  for  war.  Such  preparedness  every  sensible  man 
must  approve.  Why  then  can  we  not  turn  from  our  futile 
discussion  of  militarism  and  quarreling  about  the  number 
of  soldiers  and  munitions  of  war  that  should  be  provided, 
to  consider  in  some  degree  the  far  more  essential  form  of 
preparedness  which  has  stood  the  French  in  such  good  stead, 
and  which  alone  can  save  a  nation  in  time  of  storm  and  stress. 

The  duty  of  the  public  schools  in  regard  to  the  training  of 
citizens  capable  of  becoming  good  soldiers  in  case  of  need  has 
been  frequently  emphasized.  How  far  military  training  as 
such  should  be  given  in  connection  with  the  schools  is  a  prob- 
lem whose  discussion  does  not  concern  us  here.  It  may  well 
be  noted,  however,  that  while  military  training  does  not  seem 
in  harmony  with  the  functions  of  the  school,  a  large  part  of 
the  training  essential  for  the  soldier  is  precisely  that  essential 
in  the  training  of  the  efficient  citizen  and  of  the  hygienist 
who  can  engage  effectively  in  the  world- war  fare  against  disease. 

^From  the  Atlantic  Monthly,  Oct.  191$.  P-  559. 

[19] 


\ 


HYGIENE     AND     WAR 

Four  things,  all  must  agree,  are  essentials  in  adequate  mili- 
tary preparation. 

1.  A  good  physique  and  hygienic  personal  habits  in  the 
individual  soldier.    A  large  part  of  the  training  of  the  soldier 
at  present  consists  in  physical  and  hygienic  drill. 

2.  The  ability  of  the  individual  soldier  to  cooperate  with 
others  and  to  obey  orders. 

3.  The  ability  of  a  country  to  support  itself,  to  provide 
within  itself  all  the  essentials  for  its  life. 

4.  Adequate  military  preparation,  including  the  ability  to 
manufacture  the  necessary  munitions  of  war. 

Three  of  these  are  essentials  for  the  welfare  of  the  country 
in  times  of  peace  as  well  as  in  times  of  war.  The  public 
schools  do  not  at  present  adequately  provide  for  them.  One 
of  these,  physical  development  and  training  in  hygiene,  is  as 
essential  for  preparedness  against  the  common  enemies  of  our 
health  as  against  any  nation  that  may  attack  us.  While 
proper  training  in  obedience  and  the  development  of  the  spirit 
and  ability  to  cooperate  are  not  without  hygienic  significance, 
we  are  concerned  here  with  special  training  in  hygiene. 

The  significance  of  preparedness  can  be  seen  only  from  the 
hygienic  point  of  view.  The  original  recommendation  made  by 
President  Wilson  providing  for  an  army  of  250,000  and  a  guard 
of  400,000  represents  only  a  very  small  part  of  real  prepared- 
ness. His  guard  meant  merely  one  federal  policeman  for  250 
of  the  population;  and  the  number  of  warships,  submarines, 
and  the  like  recommended  would  be  far  from  adequate  to 
defend  our  coasts  in  case  of  real  war.  All  this  direct  prepara- 
tion for  warfare  represents  only  the  more  superficial  aspects 
of  preparedness.  Back  of  all  this  and  deeper  than  all  this  is 
a  preparation  that  must  go  on  for  years  in  the  development 
and  training  of  the  citizens  of  a  country. 

The  importance  of  this  training  in  personal  hygiene  for  the 
soldier  receives  notable  illustration  in  modern  warfare.  Sick 
soldiers  win  few  battles.  In  the  past  the  soldier's  most  deadly 
enemy  was  pestilence.  At  present  hygiene  keeps  this  enemy 
from  being  a  determining  factor.  Of  nearly  11,000  soldiers 

[20] 


HYGIENE     AND     WAR 

encamped  at  Jacksonville  for  three  months  at  the  time  of 
our  Cuban  war  some  2,000  or  more  were  ill  from  typhoid 
fever,  and  248  died  from  this  disease.  Among  nearly  13,000 
soldiers  encamped  at  San  Antonio  for  three  months,  March- 
July,  1911,  there  was  only  one  case  of  typhoid  fever,  although 
at  that  time  there  were  cases  in  the  city  of  San  Antonio. 

Such  hygienic  preparation  is  essential.  It  takes  a  long  time. 
Since  it  is  necessary  for  peace  as  well  as  for  war,  it  should  be 
earnestly  advocated  alike  by  the  most  ardent  peace  men  and 
military  men.  Instead  of  so  much  futile  talk  about  points  on 
which  we  do  not  agree,  let  us  have  at  least  some  action  in 
regard  to  this  vital  element  of  preparedness  where  all  can 
agree.  It  is  the  duty  of  men  of  all  opinions  not  to  check  the 
present  interest  in  preparedness,  but  rather  to  turn  it  into  a 
demand  for  actual  training,  into  such  fundamental  and  essen- 
tial preparation  as  all  intelligent  citizens  approve.  Whatever 
be  our  views,  all  can  agree  in  utilizing  this  interest  and  turning 
it  into  the  proper  channels. 

Again,  let  us  consider  for  a  moment  the  dangers  connected 
with  the  present  situation.  We  cannot  ignore  the  facts  in 
regard  to  the  war  and  our  own  duty  in  relation  to  them.  In 
all  this  we  are  in  a  twofold  danger.  In  the  first  place,  with 
the  attention  centered  upon  the  tragedies  of  the  war,  and 
with  the  constant  reading  of  details  of  cruelty  and  accounts 
of  the  killed  and  wounded,  our  senses  and  sympathies  are 
inevitably  dulled,  and  we  are  becoming  little  by  little  callous 
to  the  misery  of  our  friends  across  the  water. 

Equally  serious,  perhaps,  is  the  danger  that  comes  from  the 
fact  that  with  attention  so  largely  centered  upon  the  horrors 
of  war  we  are  liable  to  ignore  and  forget  the  horrors  of  peace. 

When  in  a  single  year  in  the  city  of  Boston  45  persons  were 
killed  and  852  injured  by  automobile  collisions,  where  every 
year  in  this  country  there  are  several  thousand  railway  acci- 
dents, when  in  one  of  our  Massachusetts  schoolhouses  an 
accident  can  occur  like  the  Peabody  horror,  where  children 
were  trampled  underfoot  and  burned  to  death,  and  when  at 
all  times  children  and  adults  are  suffering  and  dying  by  the 

[21] 


HYGIENE     AND     WAR 

thousands  from  preventable  diseases,  we  certainly  should  not 
expend  all  our  mental  energy  in  thinking  of  the  horrors  of 
war  across  the  ocean. 

The  horrors  of  war  are  unspeakable,  incredible,  and  incom- 
prehensible. Even  adults  with  varied  experience  cannot  grasp 
their  awfulness;  it  is  hopeless  to  attempt  to  make  children 
understand  them,  and  if  we  could,  it  would  be  unwise.  Here, 
as  in  all  education,  training  is  better  than  instruction.  In 
hygiene  especially  it  is  true  that  instruction  may  itself  be 
unhygienic.  How,  then,  can  training  be  given? 

We  cannot  take  our  pupils  to  Europe  and  have  them  visit 
the  hospitals  and  trenches,  as  Camp  Fire  Girls  and  Boy 
Scouts,  but  a  significant  amount  of  training  in  addition  to 
what  has  been  suggested  above  can  be  given  in  the  school  in 
the  way  of  giving  opportunity  actually  to  do  something  in 
the  way  of  preparing  bandages  for  the  wounded,  or  the  like, 
where  such  activities  are  practicable.  But  still  more  signifi- 
cant as  training  and  instruction,  attention  can  be  called  in 
the  schools  to  the  horrors  of  peace,  perhaps  equally  dreadful 
although  less  spectacular.  Along  with  instruction  in  regard 
to  precautions  against  fire,  against  accidents  from  teams,  cars, 
and  automobiles,  against  infectious  diseases,  pupils  may  well 
have  training  in  fire  drills,  in  intelligent  cooperation  in  meet- 
ing difficulties,  in  removing  obstacles  that  may  retard  the 
quick  emptying  of  the  schoolroom,  in  guarding  younger  chil- 
dren from  street  cars,  and  in  coasting  and  the  like;  training 
in  first  aid  to  the  injured,  some  drill  in  the  cleaning  and  band- 
aging of  imaginary  and  real  wounds,  methods  of  resuscitating 
the  drowning,  and  general  training  in  the  essentials  of  personal 
hygiene;  and  most  important  of  all,  training  in  healthful  habits 
as  regards  others — the  avoidance  of  coughing  in  the  face  of 
one's  companions,  or  any  other  behavior  that  might  carry  infec- 
tion. With  the  teaching  that  disease  is  seldom  air-borne,  but  is 
usually  conveyed  by  direct  contact  with  a  diseased  individual 
or  by  such  carriers  as  mosquitoes,  flies,  and  the  like,  there 
should  be  training  to  avoid  every  means  of  transmitting  in- 
fection, and  training  to  destroy  the  common  carriers  of  disease. 

[22] 


HYGIENE     AND     WAR 

We  must  face  the  facts  in  this  world:  there  is  trouble  and 
misery  and  we  are  beset  with  obstacles.  The  attitude  of 
facing  difficulties  should  be  developed;  and  one  who  attempts 
really  to  overcome  the  difficulties  of  life  acquires  an  interest 
in  the  conflict  itself;  the  zest  of  the  fight  becomes  worth  while 
for  its  own  sake.  This  is  one  of  the  great  lessons  of  the  present 
war.  In  the  clash  of  opinion  in  regard  to  just  how  many  actual 
soldiers  and  how  many  warships  should  be  provided  this 
lesson  of  moral  preparation  should  not  be  forgotten  and 
neglected. 

To  develop  a  young  man  physically  and  train  him  properly 
in  personal  hygiene  takes  fifteen  or  twenty  years.  But  given 
young  men  with  well-developed  and  well-trained  bodies,  with 
sound  teeth,  with  well-established  habits  of  health,  with  proper 
training  in  hygiene,  together  with  training  in  resourcefulness 
and  cooperation,  it  would  be  possible  in  case  of  need  to  give 
in  one  year  the  training  required  to  make  them  actual 
soldiers. 

The  means  of  developing  such  an  hygienic  attitude  in  the 
young  lie  not  merely  in  instruction,  but  especially  in  the  dif- 
ferent forms  of  actual  training  in  hygiene.  The  practical 
question  is  how  this  training  can  be  given.  How  shall  bad 
habits  be  broken  and  good  habits  formed  ?  The  answer  would 
be  a  long  story.  If  we  once  see  clearly  the  aim  to  be  sought, 
and  work  for  it  from  the  beginning  of  school  life,  methods 
can  be  devised. 

One  concrete  method  may  be  suggested  here.  In  every 
school  there  might  be  a  training  class  whose  special  work 
should  be  to  attend  to  the  hygiene  of  the  schoolroom  and  of 
the  individual  pupil.  Such  a  class  would  be  of  distinct  ser- 
vice to  the  school  itself;  but  to  the  members  of  the  class  it 
would  be  of  peculiar  value  developing  an  hygienic  conscience 
and  giving  actual  training  in  hygienic  measures.  What  is 
meant  may  be  made  clearer  by  an  illustration. 

Recently  I  visited  a  little  rural  school  of  excellent  character. 
The  teacher  was  intelligent,  sensible,  interested  in  her  work. 
She  had  splendid  discipline  without  any  apparent  show  of 

[23] 


HYGIENE     AND     WAR 

authority.  The  children  were  bright,  helpful,  obedient,  active, 
ready  to  play  hard  at  recess,  ready  to  work  in  the  schoolroom. 
But  apart  from  the  admirable  discipline  and  the  scholastic 
training  in  the  matter  of  studying  the  daily  lessons,  the  work 
of  the  schoolroom  seemed  to  be  all  instruction  with  little  or 
no  training.  That  there  was  plenty  of  opportunity  in  this 
school  for  training  was  obvious.  The  children  might  have 
been  more  careful  in  their  own  personal  hygiene;  their  teeth 
especially  were  not  properly  cared  for.  As  regards  the  school- 
house,  the  toilets,  although  new,  were  unsanitary;  in  the 
schoolroom  the  curtains  shut  out  the  light  from  the  upper 
half  of  the  window  where  it  was  needed;  a  little  later  in  the 
season  the  room  would  probably  be  overheated  or  improperly 
heated.  In  general,  the  sanitary  condition  could  have  been 
much  improved. 

This  school  is  typical  of  a  large  number,  probably  of  most 
schools,  in  the  rural  districts  in  this  country.  In  such  a  school 
a  training  class  in  hygiene  would  find  plenty  of  opportunity 
for  learning.  Among  its  exercises  could  be  included  the  acqui- 
sition of  habits  of  personal  hygiene,  normal  posture,  special 
care  of  the  teeth,  care  of  the  school  grounds,  cleanliness  of  the 
schoolroom,  the  use  of  fresh  earth,  if  nothing  better,  in  the 
toilets  every  day,  adjustment  of  the  windows  for  proper  ven- 
tilation with  regard  to  the  direction  of  the  wind,  the  regulation 
of  the  temperature  of  the  room,  adjustment  of  the  curtains, 
and  the  like.  Membership  in  such  a  class  should  be  made  a 
mark  of  honor,  since  service  is  always  honorable. 

With  a  tactful  teacher  such  a  class  would  give  training 
that  would  be  far  more  valuable  than  mere  instruction  in 
hygiene.  The  school  can  do  little  in  the  way  of  giving  instruc- 
tion, but  it  will  accomplish  a  great  deal  if  it  develops  an  hy- 
gienic attitude  and  fosters  the  acquisition  of  certain  habits 
of  health  that  will  remain  permanent  after  the  children  leave 
school.  Instruction  is  good  and  it  is  easy;  training  is  better 
but  it  is  difficult.  The  past  decade  has  been  a  period  of  talk 
about  school  hygiene,  the  next  decade  should  be  one  of  train- 
ing in  school  hygiene. 

[24] 


HYGIENE     AND     WAR 

In  the  secondary  school  a  militia  of  health  could  be  organ- 
ized to  take  the  place  of  the  military  cadets  that  now  exist 
in  many  high  schools.  Where  such  cadets  are  already  organ- 
ized the  change  could  easily  be  brought  about  by  developing 
the  hygienic  part  of  the  soldier's  training  and  minimizing  the 
more  purely  military  part ;  and  all  this  could  be  supplemented 
by  the  large  and  valuable  literature  of  hygiene  now  accessi- 
ble. In  a  few  schools  experiments  of  this  kind  have  already 
been  tried  with  good  success. 

Space  is  lacking  to  give  illustration  in  detail  of  the  impor- 
tance of  this  training  in  physical  development  and  personal 
hygiene;  but  for  a  single  illustration  take  the  hygiene  of  the 
teeth.  Without  good  teeth  a  man  is  not  a  suitable  candidate 
for  the  work  of  a  soldier.  And  without  proper  care  of  the 
teeth  the  soldier  has  neither  normal  digestion  nor  the  general 
well-being  necessary  for  the  most  efficient  service.  In  the 
present  war  this  has  received  noteworthy  illustration.  Pro- 
fessor Potter  of  Harvard  is  reported  to  have  said  in  a  recent 
lecture  at  the  Forsyth  Dental  Infirmary  in  Boston: 

It  is  no  uncommon  sight  to  see  squad  after  squad  of  English  'Tommies' 
making  their  way  back  to  the  nearest  hospital  in  the  hope  that  relief 
might  be  obtained  from  troublesome  molars  and  gums  which,  after  under- 
going the  terrific  hardships  in  the  trenches,  have  settled  into  a  dull  ache 
and  pain,  making  the  life  of  the  soldier  next  to  unbearable  and  greatly 
lowering  his  efficiency  as  a  soldier. 

The  German  soldier,  perhaps  through  the  foresight  of  the  long-pre- 
paring German  nation,  is  faring  the  best  of  any,  especially  as  regards  his 
teeth.  For  more  than  fifteen  years  Germany  has  been  caring  for  the  teeth 
of  its  subjects,  establishing  clinics  in  the  public  schools  and  dental  infirma- 
ries in  the  smaller  towns  and  villages  as  well  as  in  the  cities,  and  on  the 
whole  making  sure  that  no  child,  especially  a  boy,  is  allowed  to  let  his 
teeth  get  into  that  state  of  decay  which  would  necessarily  cause  his  rejec- 
tion at  the  time  of  a  call  to  the  colors. 

Thus  a  large  part  of  the  soldier's  training  consists  in  physi- 
cal development  and  training  in  hygiene ;  and  to  real  prepared- 
ness it  is  a  long  road. 

The  trouble  today  is  that  we  lack  this  moral,  physical,  and 
hygienic  preparation.  Some  states  and  cities  are  attempting 

[25] 


HYGIENE     AND     WAR 

to  atone  for  this  lack  by  requiring  military  drill  including 
physical  training  in  the  public  schools.  The  people  should 
not  delude  themselves  into  thinking  that  this  means  real 
preparation.  Much  more  than  this  is  needed — general  train- 
ing in  cooperation,  vocational  guidance  of  the  wisest  sort, 
physical  training,  the  acquisition  of  hygienic  habits,  in  a 
word,  thorough  moral  and  physical  training. 

CONCLUSION 

The  terrible  emphasis  that  the  present  war  places  upon  the 
need  of  hygiene  and  the  terrible  setback  that  the  war  has 
given  to  general  hygiene  cannot  be  realized  from  statistics, 
however  convincing;  only  concrete  illustration  such  as  is  fur- 
nished to  eye-witnesses — and  in  lack  of  that  the  concrete 
pictures  given  by  the  journalist — give  some  sort  of  idea  of 
what  the  facts  really  mean.  Mrs.  Rinehart  has  suggested 
this  briefly  for  the  horrors  of  military  life ;  the  facts  in  regard 
to  sanitary  conditions  give  opportunity  for  a  similar  picture 
on  the  hygienic  side. 

"War,"  she  writes,  "is  not  two  great  armies  meeting  in 
the  clash  and  frenzy  of  battle.  War  is  a  boy  carried  on  a 
stretcher,  looking  up  at  God's  blue  sky  with  bewildered  eyes 
that  are  soon  to  close;  war  is  a  woman  carrying  a  child  that 
has  been  injured  by  a  shell;  war  is  spirited  horses  tied  in 
burning  buildings  and  waiting  for  death ;  war  is  the  flower  of 
a  race,  battered,  hungry,  bleeding,  up  to  its  knees  in  filthy 
water ;  war  is  an  old  woman  burning  a  candle  before  the  Mater 
Dolor osa  for  the  son  she  has  given." 

We  may  add  from  the  hygienic  point  of  view:  War  is  not 
two  opposing  camps  with  their  regular  routine  and  admirable 
sanitary  regulations;  it  is  not  two  camps  deprived  for  a  few 
weeks  of  their  regular  rations,  and  required  to  do  double  work 
with  only  half  fare;  but  war  is  a  boy  dead  tired,  sleeping  in 
the  mud  by  the  wayside  while  bitten  by  noxious  insects.  It 
is  a  young  man  after  long  marches  and  fighting  kept  awake 
night  after  night  by  vermin  until  his  brain  and  mind  give 
way.  It  is  an  athlete  slaking  his  thirst  with  water  polluted 

[26] 


HYGIENE     AND     WAR 

by  the  deadly  germs  of  dysentery.  It  is  an  old  man,  the  sur- 
vivor of  many  battles  and  campaigns,  doomed  to  death  by 
freezing  his  feet  in  the  trenches,  and  the  deadly  results  that 
follow.  It  is  a  wounded  man  who  has  protected  his  own 
wounds  from  infection  by  iodine  and  first  aid  material,  dying 
from  thirst.  It  is  innumerable  women  and  children  at  home 
sick  from  overburden  and  the  lack  of  ordinary  common  food, 
or  driven  to  nervous  breakdown  by  the  anguish  and  worry 
of  a  situation  they  cannot  change. 

The  loss  and  horror  of  the  present  war  are  so  appalling 
and  stupendous  that  one  gives  up  in  despair  any  attempt 
to  grasp  its  real  significance.  It  is  beyond  our  compre- 
hension. A  single  case  of  individual  suffering  that  we 
personally  happen  to  know  about  impresses  us  more  than 
a  month's  record  of  horrors.  The  most  vivid  reports,  whether 
fictitious  or  real,  give  no  adequate  idea  of  the  actual 
conditions. 

All  this  defiance  of  hygiene  we  have  passed  over  without 
special  comment ;  but  the  significant  fact  brought  out  by  our 
study  is,  as  Dr.  Jones  expresses  it,  that  in  hygiene  "real 
efficiency  and  real  achievement  are  the  product  of  peace  and 
not  of  war." 

As  regards  hygiene  the  plain  facts  strangely  ignored  are 
these:  Mankind,  engaged  in  a  continual  life-and-death  strug- 
gle with  disease-carrying  organisms,  was  making  noteworthy 
progress,  especially  in  the  cities  of  Europe  and  America.  A 
great  victory  was  achieved  in  Havana  and  Panama  and  the 
key  to  the  conquest  of  the  tropics  was  acquired.  Then  the 
nations  withdrew  from  the  common  enemy  and  began  to  fight 
among  themselves,  spending  in  two  years  an  amount  of  money 
sufficient  practically  to  eliminate  malaria,  yellow  fever,  and 
other  tropical  diseases  from  the  more  densely  populated  tropi- 
cal centers.  The  fighting  impulse  that  should  find  legitimate 
expression  in  physical  training,  in  sport,  and  in  fighting  our 
common  disease-bearing  enemies,  is  turned  to  man's  butchery 
of  man.  The  neutral  nations,  aroused  to  the  need  of  pre- 
paredness, are  largely  forgetting  the  prime  condition  of  pre- 

[27] 


HYGIENE     AND     WAR 

paredness  for  both  peace  and  war,  namely,  physical  health 
and  training  in  personal  hygiene. 

The  following  general  conclusions  seem  justified  by  the 
facts  collected : 

1.  War  in  general,  especially  the  great  war  at  the  present 
time,   has   made  an   important  contribution   to  hygiene  by 
emphasizing  the  absolute  necessity  of  certain  fundamental 
hygienic  rules  and  principles. 

2.  The  war  has  contributed  a  few  important  new  methods 
and  devices  of  hygienic  significance,  although  the  larger  part 
of  its  contribution  has  been  to  medicine  and  surgery.     But 
it  should  be  remembered  that  the  progress  even  of  military 
hygiene  and  sanitation,  although  stimulated  by  war,  has  been 
made  for  the  most  part  in  times  of  peace.     The  study  of 
typhus  and  typhoid  fever,  the  investigation  of  yellow  fever 
and  its  elimination  from  Havana,  New  Orleans  and  Panama, 
the  conquest  of  malaria,  cholera  and  other  diseases,  were 
made  not  during  war  but  in  times  of  peace. 

3.  The  evidence  shows  that  the  war  has  seriously  inter- 
fered with  general  hygiene,  with  the  warfare  that  is  continu- 
ally being  waged  between  man  and  his  insect  enemies.    When 
more  complete  data  are  at  hand  the  evidence  of  this  will 
probably  be  much  more  overwhelming,  but  even  what  is  now 
available  shows  the  serious  setback  to  general  hygiene  that 
has  resulted  in  the  European  countries  engaged  in  the  present 
war. 

4.  The  psychological  basis  in  human  character  which  under 
certain  conditions  seems  inevitable  to  lead  to  war  has  been 
in  part  made  clear.     But  the  so-called  fighting  instinct,  as 
usually  exhibited  in  human  beings,  is  apparently  merely  a 
differentiation  from  the  fundamental  impulse  to  activity  and 
self-assertion.     Any  form  of  activity  developed  with  similar 
emotional  associations  is  equally  instinctive. 

5.  Hence  a  substitute  for  war  can    be    found.      This   is 
suggested  by  hygiene.     It  is  to  be  found  largely  in  physical 
education,  in  ample  opportunity  for  play,  and  in  hygienic 
training  which  provides  for  suitable  periods  of  rest  and  recrea- 

[28] 


HYGIENE     AND     WAR 

tion  for  all  classes  in  society.  Besides  this,  hygiene  suggests 
another  substitute,  namely,  the  expression  of  the  fighting 
instinct  in  the  inevitable  warfare  which  the  individual 
as  well  as  the  community  must  unceasingly  wage  against 
the  common  enemies  of  human  health.  The  imperative 
necessity  of  this  warfare,  its  continual  existence,  and  the 
rewards  that  come  from  waging  it,  when  rightly  understood, 
would  give  the  strongest  incentives  for  the  expenditure 
of  all  the  fighting  energy  that  youth  as  well  as  mature  men 
possess. 

6.  To    show    the    significance    of    this    hygienic    warfare 
and  to  prepare  for  it,  long  and  efficient  training  is  neces- 
sary.    This  can  be  given  largely  in  connection  with  school 
education. 

7.  Concrete  methods  of  such  training  can  be  furnished  by 
training  classes  in  hygiene  in  the  elementary  grades,  by  health 
cadets,  a  militia  of  health,  in  the  high  school  and  higher  institu- 
tions.   And  all  such  organizations  as  the  Boy  Scouts  and  Camp 
Fire  Girls  should,  as  they  often  do,  make  this  hygienic  train- 
ing an  especially  important  feature  in  their  drill.    This  is  the 
part  of  military  training  to  be  emphasized  and  developed, 
and  this  is  important  for  the  soldier  whose  duty  must  be  to 
defend  his  country  as  well  as  for  the  soldier  who  enlists  in  the 
perennial  conflict  waged  by  hygiene. 

8.  Preparation  of  the  citizens  of  a  country  for  national 
defense  is  in  large  part,  probably  in  three  essentials  out  of 
four,  precisely  the  preparation  that  efficient  citizens  should 
receive — the  training  in  cooperation,  in  habits  of  health  and 
warfare  against  disease,  and  in  vocational  training  to  enable 
them  to  produce  the  necessities  of  life. 

9.  However  important  the  contribution  of  war  to  hygiene 
has  been  in  the  past,  scientific  method  has  now  developed 
to  such  a  degree  that  laboratory  experiments  under  controlled 
conditions  make  the  crude  experiments  of  warfare  of  relatively 
little  value. 

10.  The  evolution  of  both  military  and  civic  training  will 
be  largely  in  the  same  direction.  More  and  more  the  training  of 

[29] 


HYGIENE     AND     WAR 

the  soldier  becomes  training  in  hygiene;  and  in  the  near  future 
it  may  be  hoped  that  the  soldier  will  become  a  police  health 
inspector  and  hygienist.  And  all  forms  of  education  and  train- 
ing of  youth  that  forecast  the  future  will  place  the  emphasis 
on  training  that  will  prepare  the  individual,  not  only  to  pre- 
serve his  own  personal  health,  but  to  help  eradicate  the  un- 
sanitary conditions  that  still  exist  in  modern  life. 


[30] 


I.   INTRODUCTION 

Special  Hygienic  Points. — From  a  strictly  hygienic  point  of 
view,  this  study  has  brought  out  the  following: 

1.  The  reciprocal  effects  of  hygiene  and  sanitation  upon 
soldier  and  civilian  in  times  of  war  and  peace. 

2.  Suggestive  data,  especially  those  brought  out  by  recent 
wars  and  military  operations  (such  as  work  in  Panama,  Vera 
Cruz,  San  Francisco,  etc.)  which  may  be  applied  to  the  hygiene 
and  sanitation  of  the  general  public  at  all  times. 

3.  Sources  of  material  bearing  on  the  sanitary  and  hygienic 
phases  of  war  and  military  life,  for  compilers  of  texts,  teachers, 
lecturers,  etc. 

4.  The  part  played  by  war  and  peace  in  developing  the 
subject  of  hygiene  and  putting  it  into  practice. 

The  fourth  point  has  been  covered  by  Dr.  Burnham  in  his 
introduction.  The  first  three  will  be  included  in  the  text. 

General  Conclusion. — But  though  the  topics  above  men- 
tioned are  valuable,  this  investigation  has  revealed  the  fol- 
lowing conclusions  as  most  important : 

First.  The  health  and  strength  of  the  general  population  is  the 
greatest  preparedness  of  the  nation,  not  armor,  ships,  etc. 

Second.  The  extreme  fallacy  of  the  tendency  to  give  credit 
to  war  for  incidental  and  valuable  influences  and  products  that 
spring  up  as  by-products,  which  would  have  come  in  the  natural 
course  of  events. 

Third.  The  inadequacy  of  war  in  attaining  the  purpose  for 
which  it  is  started  or  supposed  to  be  waged — as  economic  adjuster 
or  factor;  as  a  promoter  of  ethics;  as  a  developer  of  the  race. 

Fourth.    The  destructiveness  and  evil  influence  of  war. 

Fundamentals  of  Preparedness. — It  will  be  shown  that  the 
great  achievements  of  military  hygiene  have  been  attained 
and  made  possible  in  times  of  peace,  not  war.  Facts  show 
that  the  soldier  of  any  given  time  is  the  product  of  the  general 
population — no  better,  no  worse,  and  that  as  a  fighting  engine 


HYGIENE     AND     WAR 

his  efficiency  depends  upon  the  source  whence  he  springs. 
However  careful  the  military  authorities  may  wish  to  be,  it 
is  impossible  for  them  to  maintain  conditions  that  make  for 
health  and  vigor  among  the  contending  people  under  the 
stress  of  war,  especially  if  it  be  long  continued. 

Limitations  Imposed  by  War. — Such  sanitary  measures  as 
have  been  carried  on  in  Cuba,  Porto  Rico,  Panama,  the  Philip- 
pines, Vera  Cruz,  etc.,  could  not  have  been  initiated,  let  alone 
perfected,  in  time  of  war.  Nor  would  careful  experimentation 
be  possible  at  such  times.  The  battle  against  yellow  fever 
was  begun  long  years  ago  in  peace  times  and  in  such  times 
finally  won.  War  leaves  little  or  no  time  for  careful  investiga- 
tion of  ways  and  means  of  preserving  and  mending  men.  Such 
are  its  brutalities  that  they  may,  in  truth,  blind  even  the  anti- 
vivisectionist  to  such  a  degree  that  even  he  will  tolerate  rank 
empirical  methods,  trial  and  error  procedures,  that  no  one 
would  bear  in  peace  times.  But  positive  results  come  more 
quickly,  more  surely  and  with  more  permanency  under  the 
real  experimental  conditions  possible  only  in  times  of  peace. 

The  development  of  certain  industries,  such  as  chemical, 
steel,  etc.,  needs  no  such  artificial  stimulus.  The  airship  is 
not  the  product  of  war.  It  is  the  result  of  the  long,  patient 
efforts  of  such  men  as  Langley  who  would  have  had  no  such 
opportunities  for  investigations  in  war  times  as  peace  afforded 
them. 

Importance  of  Hygiene  at  all  Times. — It  will  be  shown  that 
the  careful  habits  of  dress,  conduct,  eating,  sleeping,  etc., 
required  of  the  soldier  are  quite  as  necessary  for  civilian  and 
soldier  in  times  of  peace.  Facts  indicate  that  because  of  the 
higher  ideals  developed  along  these  and  other  lines  by  the 
volunteer  in  his  pursuit  of  the  occupations  and  professions  of 
peace,  he  becomes  an  efficient  soldier  more  readily  when 
needed.  Hence  this  training  in  hygiene,  obtained  in  peace  times, 
produces  positive  results.  In  war  its  results  are  negated. 

Upon  the  advent  of  war,  the  civilian  population  is  sud- 
denly called  upon  to  readjust  itself,  to  change  its  food,  clothes, 
habits,  etc.  Such  is  the  make-up  of  man,  that  however  will- 

[32] 


HYGIENE     AND     WAR 

ing  or  desirous  of  doing  this  he  may  be,  he  cannot  do  it.  Data 
will  be  presented  with  reference  to  the  food  supply  of  the 
German  people,  showing  what  is  possible  for  them  to  do  if 
they  are  able  to  carry  out  the  plans  suggested.  Some  changes 
which  English  authorities  think  necessary  for  their  country 
will  also  be  indicated.  No  one  claims  that  these  ideals  and 
admonitions  will  or  can  be  carried  out  even  reasonably  well. 
Habits  of  a  life  time,  of  a  generation,  of  a  race,  cannot  be 
changed  over  night. 

Instead  of  war  contributing  solutions,  it  merely  burdens 
peace  with  the  problems  of  finding  remedies  for  its  woes. 

Inadequacy  of  War. — For  a  comprehensive  discussion  of  the 
inadequacy  of  war  in  accomplishing  the  ends  for  which  it  is 
waged — as  an  economic  adjuster,  as  a  promoter  of  ethics,  as 
a  developer  of  the  race — and  of  its  destructiveness  and  evil 
influences,  a  complete  historical  treatment  might  be  neces- 
sary. But  orientating  ourselves  from  the  viewpoint  of  hy- 
giene, simplifies  the  case.  And  for  this  reason  we  call  atten- 
tion to  these  points,  with  incidental  contribution  to  other 
phases.  The  factors  are  so  closely  related  that  their  influences 
intermingle,  each  in  turn  affecting  the  others. 

So  far  as  history  shows,  treaties  concluding  wars  show  little 
agreement  with  the  purposes  for  which  the  conflicts  were 
undertaken.  It  is  well  to  recall  that  our  War  of  1812  really 
did  not  solve  the  difficulties  for  which  it  was  waged.  The 
Mexican  War  left  us  a  heritage  of  suspicion  and  hate,  the 
results  of  which  we  yet  feel  and  regret.  Our  Spanish-American 
War  was  for  the  liberation  of  Cuba,  an  object  which  would 
probably  have  been  attained  through  peaceful  diplomatic  pro- 
cedure had  it  not  been  for  the  jingoism  of  the  press  and  petty 
politics  among  our  people.  It  left  us  a  legacy  of  more  suspi- 
cion on  the  part  of  our  southern  neighbors,  an  island  incubus 
which  the  pro-militarists  ever  hold  up  as  justification  of 
unlimited  naval  expenditure,  and  an  excuse  for  quarrels  in 
the  Orient.  Perhaps  the  investigation  of  the  International 
Commission  of  Inquiry  into  the  Balkan  Wars  indicates,  typi- 
cally, the  usual  concurrence  of  cause  with  effect  when  war  is 

[33] 


HYGIENE     AND     WAR 

the  instrument  used.  Since  this  investigation  represents — what 
has  been  lacking  so  often  heretofore — a  real  attempt  to  ascer- 
tain all  the  conditions  of  the  contending  parties,  soldiers  at 
the  front  and  at  home,  civilians  at  home,  in  the  territories 
invaded,  refugees,  moral  conditions,  economic,  etc.,  we  shall 
quote  at  length  from  it.  Undertaken  by  men  as  impartial  as 
it  is  possible  for  humans  to  be,  careful  investigators  who 
verified  wherever  possible  every  statement,  its  conclusions 
are  of  vital  significance,  especially  at  this  time.  The  members 
of  this  Commission  visited  the  various  countries  involved  in 
the  Balkans  Wars,  talked  with  men  in  authority,  with  the 
refugees,  with  the  peasants,  etc.  This  was  at  the  close  of  the 
second  war  when,  as  we  shall  see,  the  effects  were  still  vividly 
present.  As  we  have  already  shown,  actual  facts  were  not 
obtainable  in  many  cases.  In  some  cases  the  governments 
concerned  would  not  furnish  them.  In  others,  machinery  for 
their  collection  was  absent  when  the  facts  were  available. 
The  Commission  has  carefully  made  plain  the  source  of  their 
data  and  properly  evaluated  it.  (194) 

The  Balkan  War  was  undertaken  for  the  purpose  of  libera- 
tion but,  this  accomplished,  the  freed  men  turned  to  rend 
each  other!  No  inquisition  reveals  greater  horrors  than  were 
perpetrated  by  the  Balkan  nations  upon  each  other.  After 
suffering  years  of  oppression,  enlarging  bands — perhaps  more 
or  less  brigand  in  their  nature,  especially  in  the  beginning — 
began  to  create  trouble  for  the  Turks.  They  gathered  suffi- 
cient momentum  to  lead  them  to  form  a  sort  of  Committee  or 
'Organization'.  No  longer  able  to  endure  the  oppression 
under  which  they  lived,  a  portion  of  the  more  radical  members 
of  the  organization  set  about  through  violent  measures  to 
arouse  Europe  to  their  needs.  The  Commission  says: 

It  is  the  climax  of  the  'Internal  organization'  and  that  of  its  fall.  The 
heroism  of  the  rebels  breaks  itself  against  the  superior  force  of  the  regular 
army.  The  fighting  ratio  is  one  to  thirteen,  26,000  to  351,000;  there  are 
thousands  of  deaths  and,  in  the  final  result,  200  villages  ruined  by  Turkish 
vengeance,  12,000  houses  burned,  3,000  women  outraged,  4,700  inhabitants 
slain,  and  71,000  without  a  roof. 

[34] 


HYGIENE     AND     WAR 

In  a  short  time  the  alliance  of  Servia,  Bulgaria,  Monte- 
negro, and  Greece  was  formed.  With  remarkable  effective- 
ness, they  soon  attained  a  possibility  of  the  toleration  and 
liberation  for  which  they  had  contended.  At  this  point  they 
began  to  quarrel  among  themselves,  with  what  dire  results 
we  shall  let  the  report  show.  Keeping  in  mind  that  this  first 
Balkan  War  was  for  liberation,  toleration,  freedom,  let  us  see 
how  the  would-be- freed  men  act: 

On  a  close  view  of  what  happened  in  Macedonia,  as  the  Balkan  armies 
marched  southward,  this  War  of  Liberation  assumes  a  more  sordid  and 
familiar  aspect.  It  unleashed  the  accumulated  hatreds,  the  inherited 
revenges  of  centuries.  It  made  the  oppressed  Christians  for  several  months 
the  masters  and  judges  of  their  Moslem  overlords.  It  gave  the  oppor- 
tunity of  vengeance  to  every  peasant  who  cherished  a  grudge  against  a 
harsh  landlord  or  a  brutal  neighbor.  Every  Bulgarian  village  in  northern 
Macedonia  had  its  memory  of  sufferings  and  wrongs.  For  a  generation 
the  insurgent  organization  had  been  busy  and  the  normal  condition  of  these 
villages  had  been  one  of  intermittent  revolt.  The  inevitable  Turkish 
reprisals  had  fallen  now  on  one  village  and  now  on  another.  Search  for 
arms,  beatings,  tortures,  wholesale  arrests,  and  occasional  massacres  were 
the  price  which  these  peasants  paid  for  their  incessant  struggle  toward  self- 
government.  In  all  these  incidents  of  repression,  the  local  Moslems  had 
played  their  part,  marching  behind  the  Turkish  troops  as  bashi-bazouks 
and  joining  in  their  work  of  pillage  and  slaughter.  Their  record  was  not 
forgotten  when  the  Bulgarian  victories  brought  the  chance  for  revenge. 
To  the  hatred  of  the  races  there  was  added  the  resentment  of  the  peasan- 
try against  the  overlords  (beys)  who  for  generations  had  levied  a  heavy 
tribute  on  their  labor  and  their  harvests.  The  defeat  of  the  Turkish  armies 
meant  something  more  than  a  political  change.  It  reversed  the  relation 
of  conqueror  and  serf;  it  promised  a  social  revolution.  (194,  p.  71) 

Nor  was  it  only  the  regions  occupied  by  the  Bulgarians  which  suffered. 
In  the  province  of  Monastir,  occupied  by  Serbs  and  Greeks,  the  agents 
of  the  (British)  Macedonian  Relief  Fund  calculated  that  eighty  per  cent, 
of  Moslem  villages  were  burned.  Salonica,  Monastir  and  Uskub  were 
thronged  with  thousands  of  homeless  and  starving  Moslem  refugees,  many 
of  whom  emigrated  to  Asia.  (194,  p.  72) 

The  Turks  stated  to  the  Commission  that  most  of  these 
atrocities  occurred  during  the  early  weeks  of  the  war.  And 
that  is  as  might  be  expected  and  as  we  have  found  in  the 
present  war.  The  passions  do  subside  as  more  and  more 
efforts  are  required  for  battles,  etc.  How  the  oppressed,  when 

[35] 


HYGIENE     AND     WAR 

liberated,  turn  to    )ppress  their  opponents  is  clearly  seen  in 
the  enforced  conversions  of  the  pomaks.     (194,  pp.  77—78) 

The  Holy  Synod  argued  that  since  force  had  been  used  to  convert 
the  pomaks  to  Islam,  force  might  fairly  be  used  to  reverse  the  process. 
The  argument  is  one  proof  the  more  that  races  whose  minds  have  been 
molded  for  centuries  by  the  law  of  reprisal  and  the  practice  of  vengeance 
tend  to  a  common  level  of  degradation. 

Apropos  of  the  present  European  conflict  and  the  jingoism 
being  circulated  through  the  American  press  for  the  purpose 
of  launching  us  on  a  militaristic  policy,  the  following  from  the 
Report  (Balkan)  is  significant: 

It  required  no  artificial  incitement  to  produce  the  race  hatred  which 
explains  the  excesses  of  the  Christian  Allies,  and  more  especially  of  the 
Bulgarians  toward  the  Turks.  Race,  language,  history  and  religion  have 
made  a  barrier  which  only  the  more  tolerant  minds  of  either  creed  are  able 
wholly  to  surmount.  It  is  easy  to  explain  the  excesses  of  which  Greeks 
and  Bulgarians  were  guilty  toward  each  other.  The  two  races  are  sharply 
distinguished  by  temperament.  A  traditional  enmity  has  divided  them 
from  the  dawn  of  history,  and  this  is  aggravated  in  Macedonia  by  a  certain 
social  cleavage.  But  for  a  year  the  two  nations  had  been  allies,  united 
against  a  common  enemy.  When  policy  dictated  a  breach,  it  was  neces- 
sary to  prepare  public  opinion;  and  the  Greek  press,  as  if  by  a  common 
impulse,  devoted  itself  to  this  work.  To  the  rank  and  file  of  the  three 
Balkan  armies,  the  idea  of  a  fratricidal  war  was  at  first  repugnant  and 
inexplicable.  The  passions  of  the  Greek  army  were  aroused  by  a  daily 
diet  of  violent  articles.  The  Greek  press  had  had  little  to  say  regarding  the 
Bulgarian  excesses  against  the  Turks  while  the  facts  were  still  fresh,  and 
indeed  none  of  the  allies  had  the  right  to  be  censorious,  for  none  of  their 
records  were  clean.  Now  everything  was  dragged  to  light,  and  the  records 
of  the  Bulgarian  bands,  deplorable  in  itself,  lost  nothing  in  the  telling.  Day 
after  day  the  Bulgarians  were  represented  as  a  race  of  monsters,  and  public 
feeling  was  roused  to  a  pitch  of  chauvinism  which  made  it  inevitable  that 
war,  when  it  came,  should  be  ruthless.  In  talk  and  in  print  one  phrase 
summed  up  the  general  feeling  of  the  Greeks  toward  the  Bulgarians,  'Dhen 
einai  anthropoi'  (They  are  not  human  beings).  In  their  excitement  and 
indignation  the  Greeks  came  to  think  themselves  the  appointed  avengers  of 
civilization  against  a  race  which  stood  outside  the  pale  of  humanity. 
(194,  p.  95) 

Importance. — A  careful  perusal  of  the  American  press  just 
prior  to  the  outbreak  of  our  war  with  Spain  will  reveal  the  same 

[36] 


HYGIENE     AND     WAR 

general  chauvinism.  It  is  to  be  regretted  that  we  have  no 
adequate  medical  history  of  any  war.  Indeed,  it  is  but  in  most 
recent  years  that  the  significance  and  importance  of  Military 
Hygiene  has  been  acknowledged  by  military  men  and  civilians. 
Even  in  the  Boer  War,  certain  British  officials  looked  with 
contempt  upon  the  medical  branch  of  the  service.  The  Jap- 
anese (28)  surprised  (90)  the  world  into  a  more  serious  regard 
for  hygiene  and  sanitation  (138).  In  their  Manchurian  cam- 
paign, they  were  able,  on  account  of  their  thorough  medical 
organization  and  their  observance  of  its  orders,  to  return  one- 
third  of  their  wounded  to  active  service  within  a  month  (365). 
Fifteen  hundred  and  ninety-three  cases  of  cholera  were  found 
among  232,346  Japanese  troops  sent  to  the  field.  Upon  the 
return  of  these  troops  there  were  but  37  easily  isolated  cases 
and  only  205  men  were  sick  over  fourteen  days  after  the  return. 
Such  excellent  results  were  achieved  through  the  sanitation 
and  hygiene  practised  by  this  army.  (147,  212,  213,  214,  414, 

415) 

Recency  of  Emphasis  upon  Hygiene. — In  the  last  ten  years, 
the  medical  staffs  of  the  armies  of  the  leading  nations  have 
been  revised.  Marvelous  results  have  followed.  Owing  to 
excellent  organization,  the  Swiss  mobilized  their  army  of  300,- 
ooo  in  two  days  and  distributed  them  to  the  frontier  in  from 
five  to  six  days.  During  August,  1914,  they  had  but  44 
deaths — 5  from  sunstroke,  5  from  delirium  tremens,  6  from 
suicide  (mental  derangement),  13  from  accidents,  and  2  from 
typhoid.  They  had  7  cases  of  scarlet  fever  and  n  of  typhoid. 
(367,  404) 

In  1911,  vaccination  for  typhoid  was  made  compulsory  in 
the  United  States  Army  and  Navy  for  all  under  forty-five 
years  who  had  not  had  the  disease.  In  1898,  in  a  force  of 
IO>759  there  were  2,693  cases  of  probable  and  certain  typhoid, 
of  whom  248  died.  While  in  1911,  in  a  force  of  12,802  on  the 
Texas  border,  there  were  but  2  cases  and  no  deaths.  It  should 
also  be  borne  in  mind  that  sanitation  and  hygiene  received 
much  more  attention  with  the  latter  than  with  the  former 
troops.  (142) 

[37] 


HYGIENE     AND     WAR 

Major  Lelean  states  that  from  1903-1912,  the  death  rate 
fell  to  33  per  cent,  and  the  total  sickness  rate  to  48  per  cent,  of 
the  same  rates  for  1855  m  tne  whole  British  Army.  In  1855 
the  death  rate  of  the  army  was  88  per  cent,  more  than  that  of 
the  general  population.  In  1905,  it  was 22  percent,  less  than 
that  of  the  general  population.  During  six  years'  experience 
with  12,000  Indian  troops  in  India,  there  was  but  one  small 
outbreak  of  cholera,  while  the  native  population,  because  of 
their  neglect  of  hygiene  and  sanitation,  died  at  the  rate  of 
83,000  per  year.  (133) 

But  such  achievements  are  not  to  be  attributed  to  the 
medical  corps  alone  but  also  to  the  development  of  interest  in, 
and  general  observance  of,  hygienic  principles  by  the  whole 
population,  such  as  has  been  promulgated  through  our  schools, 
school  nurses,  physicians,  medical  inspection,  etc.  Germany 
has  led  in  this,  with  the  result  that  her  army  consists  of  a 
finely  equipped  body  of  men — men  physically  fit. 

Herbert  Jones  states  that  it  is  now  possible  with  modern 
surgery  and  medicine  to  return  to  active  service  thousands 
who  in  former  wars  would  have  perished  or  been  useless  for 
the  promotion  of  war.  We  may  remark  parenthetically  that 
one  optimistic  German  writer  reports  88.5  per  cent,  of  German 
wounded  returned  to  active  service.  He  asserts  that  in  the 
Crimean  War  28  per  cent,  of  the  wounded  died;  in  the  Italian 
War  of  1859,  17  per  cent.;  in  the  Prussian  WTar  with  Denmark, 
J5-5  percent.;  in  the  War  of  1870-1871,  n.i  per  cent.;  in  the 
Russo-Japanese  War,  Japanese  6.8  percent.,  and  Russians  3.2 
per  cent.  General  returns,  however,  seem  to  indicate  a  higher 
fatality  among  wounded.  Jones  attributes  the  success  of 
modern  surgery  and  medicine  not  alone  to  their  advanced 
stage  but  also  to  the  general  conditions  of  living.  He  points 
out  that  twenty  years  ago  in  England  40  per  cent,  of  recruits 
were  rejected;  that  ten  years  later  this  was  reduced  to  30  per 
cent., and  that  now  it  is  just  a  little  over  20  percent. — and  that, 
too,  under  most  stringent  requirements.  This  means  that  if 
the  percentage  of  rejections  were  now  what  it  was  twenty 
years  ago,  there  would  be  one  half  million  fewer  unmarried 

[38] 


HYGIENE     AND     WAR 

men  in  England  and  Wales  alone  available  for  service.  Thus 
the  Public  Health  Service  has  added  over  500,000  to  the  poten- 
tial army.  (109) 

Field  Invoked. — The  business  of  the  soldier  is  to  fight  and 
to  march.  To  do  these  efficiently,  he  must  be  sound,  must 
have  good  health.  The  source  of  the  soldier  is  the  general 
population.  Hence  it  is  quite  essential  that  this  source  be 
vigorous  and  in  good  condition.  For  this  reason,  military 
hygiene  must  not  only  include  those  factors  which  concern 
the  health  of  the  soldier  as  much  in  times  of  peace  and  war, 
but  it  must  also  consider  those  factors  which  enter  in  to  make 
him  what  he  is  at  the  time  of  his  enlistment  (38).  In  short, 
it  must  treat  of  all  those  factors  which  determine  the  health 
of  man. 

If  we  can  acquire  and  use  the  same  habits  of  sanitation, 
hygiene,  and  cleanliness  in  peace  that  soldiers  are  forced  to 
use  in  war,  war  will  have  done  good,  at  least,  in  this  respect. 
As  it  is  now,  the  victory  will  lie  with  the  War  God,  rather 
than  as  formerly  with  disease  and  pestilence. 


[39] 


II.   DESTRUCTIVENESS  OF  WAR  THROUGH 
DISEASES  AND   WOUNDS 

We  have  already  indicated,  to  some  extent,  the  loss  from 
these  sources.  We  have  shown  that  it  is  from  disease,  during 
war  and  following  in  its  wake,  that  both  the  army  and  civilians 
suffer  most.  Not  those  slain  in  battle  are  the  great  loss,  but 
those  who  remain  maimed,  unable  to  support  themselves — 
those  who  are  diseased  and  others  whose  afflictions  are  such 
that  they  carry  infection  broadcast. 

TYPES  OF  DISEASES 

As  Woods  Hutchinson  (102)  suggests,  a  catalog  of  diseases 
with  which  man  is  afflicted  is  practically  a  list  of  those  suffered 
by  soldiers.  There  are  few,  if  any,  peculiar  to  warfare.  The 
presence  of  the  various  diseases  varies  with  the  times  and 
circumstances.  In  such  a  war  as  the  present  one,  because  of 
the  number  of  nations,  races,  their  divergent  sources,  etc.,  the 
variety  of  afflictions  is  probably  larger  than  in  any  previous 
war  and  the  possibilities  of  new  developments  in  the  progress 
of  these  diseases,  their  treatment  with  the  various  races,  etc., 
is  great.  Just  as  the  Spanish-American  War  emphasized  the 
destructive  effects  of  typhoid,  the  Crimean  War,  those  of 
cholera,  so  the  present  war  is  calling  attention  most  conspicu- 
ously to  typhoid,  typhus,  tetanus,  and  cholera.  Mental 
troubles  likewise,  partly  because  of  their  prevalence  and  partly 
because  physicians  are  now  more  able  to  diagnose  them,  are 
presenting  data  and  serious  problems. 

Writers  on  military  hygiene  are  seeking  to  impress  upon  the 
soldier,  as  physicians  are  upon  civilians,  the  fact  that  most 
diseases  are  preventable  and  that  prevention  is  much  better 
and  surer  than  treatment  and  cure,  (i,  n,  69,  98,  44,  303, 
162,  264,  36,  301,  93,  94,  381,  237,  280) 

Deficiency  Diseases. — Among  the  types  of  diseases  classed 
as  deficiency  diseases  may  be  mentioned  scurvy,  disease  due 

[40] 


HYGIENE     AND     WAR 

to  dental  caries,  and  beri-beri.  Such  diseases  seem  to  arise 
from  the  absence  of  some  element  in  the  food  taken.  Lelean 
also  classifies  neurasthenia  under  this  type.  (133,  ch.  I.) 

He  states  that  food  must  contain  vitamines  if  they  are  to 
serve  their  purpose.  Vitamines  are  nitrogenous,  metabolic 
bodies  which  are  unstable  because  they  contain  more  or  less 
dissociated  ions.  Heat  associates  these  ions  but  in  so  doing 
destroys  their  character  as  vitamines.  Cabbage  juice,  for 
example,  loses  its  vitamines  at  60  deg.  Fahr.  "Every  defi- 
ciency disease  is  apparently  in  aetiological  relation  with  some 
specific  vitamine." 

Beri-beri. — The  old  theory  that  beri-beri  is  a  place  disease, 
i.  e.,  confined  to  particular  locations  especially  in  the  East, 
the  Malay  Archipelago,  etc.,  has  been  proven  untenable.  It 
is  not  a  microbe  disease  but  is  a  result  of  deficient  food.  It 
is  found  among  rice-eating  nations  and  occurs  only  in  con- 
nection with  the  use  of  finely  milled  grain  of  this  sort.  In 
the  product  of  this  milling,  certain  of  the  outer  layers  are 
omitted  from  the  flour.  It  has  been  proven  that  these  outer 
layers  contain  the  vitamines  which  give  the  full  food  value 
to  the  rice.  Hence  by  taking  the  whole  grain  this  disease 
can  be  eradicated.  (288) 

Scurvy. — Eighty- three  per  cent  of  the  garrison  of  Port  Arthur 
in  the  Russo-Japanese  War  are  said  to  have  suffered  from 
scurvy.  It  has  been  known  for  some  time  that  this  malady  occurs 
only  in  connection  with  mal-nutrition.  The  addition  of  one- 
half  ounce  daily  of  lime  juice  to  the  food  has  proven  helpful. 

Infectious  Diseases. — The  soldiers  are  subject  to,  and  espe- 
cially exposed  to,  every  type  of  infectious  disease.  Among 
those  connected  with  the  intestinal  tract  may  be  mentioned 
typhoid,  typhus,  ambulatory  enteric  (typhoid),  premonitory 
diarrhoea,  dysentery,  and  cholera. 

Diseases  of  Present  War. — Illustrative  of  the  extent  and 
variety  of  diseases  present  among  soldiers  in  war,  we  offer  a 
list  of  those  which  have  been  already  reported. 

Ankylostomiasis,  in  Egypt;  beri-beri,  cholera,  and  plague, 
diarrhoea,  dysentery,  kala  azar,  typhus,  typhoid,  polyneu- 


J 


HYGIENE     AND     WAR 

ritis,  tetanus,  various  mental  diseases,  i.  e.,  nostalgia,  shock, 
etc.,  various  sexual  diseases,  'gun  deafness',  'air  sickness', 
etc.  (140,  144,  302,  150,  320,  167,  168,  169) 

General. — We  may  expect  every  second  man  to  spend  some 
time  in  the  hospital.  Probably  most  cases  will  be  due  to 
sore  feet  or  digestive  troubles.  Diseases  due  to  exposure  as 
polyarthritis,  pneumonia,  bronchitis,  etc.,  will  be — in  fact, 
have  been — frequent.  Already  in  the  Russian  army  cholera 
has  been  at  work.  Owing  to  recent  progress  in  hygiene,  that 
country  as  a  whole  has  been  able  to  keep  the  .average  loss 
from  typhoid,  typhus,  smallpox,  and  dysentery  about  normal. 
In  1913,  cholera  seemed  to  have  abated  there.  In  1914, 
145  cases  of  cholera  and  45  of  bubonic  plague  have  been 
reported.  In  India  the  plague  rate  is  about  the  same, 
amounting  to  about  1,500  cases  per  week.  It  is  from  troops 
from  that  country  that  danger  is  to  be  expected.  Herpes  is 
rare  and  para-typhoid  is  seldom  transmitted  by  contact. 

Weichselbaum  correctly  writes  that  the  chief  war  epidemics 
are  typhus,  typhoid,  flux,  and  cholera,  and  that  they  have, 
already  appeared.  He  suggests  that  they  enter  the  digestive 
tract  by  way  of  the  mouth,  owing  to  improper  handling  of  the 
food,  etc.  Germs  perish  easily  through  (i)  desiccation;  (2) 
acids;  (3)  decay;  (4)  high  temperature,  and  he  might  have 
added  direct  sunlight.  Hence  they  are  usually  harmless  on 
dry  bread,  on  acid  or  dry  fruit,  on  cooked  or  heated  food. 
As  methods  of  prevention,  then,  the  soldier  should  wash  his 
hands  often,  thoroughly  disinfect  when  necessary,  and  wash 
the  food. 

Mayer  gives  the  following  facts:  From  Sengal,  we  may  get 
tuberculosis,  lepra,  bubonic  plague,  trypanosomiasis,  beri- 
beri, craw-craw,  guinea  worm,  filariasis,  bilharaziasis,  ankylos- 
tomiasis,  sand-fleas,  yellow  fever;  from  Algeria,  trachoma 
and  Malta  fever;  from  India,  kala  azar;  from  East  Siberia 
and  Caucasus,  relapsing  fever.  That  leprosy  will  be  smuggled 
into  Germany,  he  thinks  unlikely.  Bubonic  plague  could 
easily  enter  through  rats.  He  does  not  anticipate  pneumonia 
in  Germany  unless  it  comes  through  Russia.  Among  the 

[42] 


HYGIENE     AND     WAR 

Belgians,  cases  of  sleeping  sickness  have  already  been  found. 
He  says  it  is  spread  through  flies.  It  is  possible  to  fight  ankylos- 
tomiasis  by  controlling  stools  through  use  of  thymol.  (150) 

The  lesson  relative  to  the  significance  and  importance  of  a 
well-organized  and  equipped  medical  corps  learned  by  the 
army  authorities  from  the  Spanish-American  War  has  func- 
tioned, as  is  shown  in  the  report  of  the  surgeon-general  for 
1913.  The  report  shows  conditions  in  the  United  States  Army 
admirable  as  a  whole.  There  had  been  a  decrease  of  1 8  per 
cent,  in  the  admission  of  sick  and  the  rate  was  the  lowest  it 
has  been  for  years.  The  rate  of  23.97  out  of  a  thousand 
incapacitated  for  the  year  was  the  lowest  on  record.  The 
death  rate  was  a  little  higher  than  usual,  but  this  was  due  to 
a  railroad  accident  killing  17.  There  were  but  3  cases  of 
typhoid  for  the  year. 

In  1909,  there  were  173  cases  with  18  deaths;  1910,  142 
cases,  10  deaths;  1911,  44  cases,  6  deaths;  1912,  18  cases,  3 
deaths. 

Prophylaxis  was  begun  voluntarily  this  year.  Sanitary 
measures  and  inoculation  with  anti-typhoid  toxin  had  been 
kept  up.  Tuberculosis  was  low  and  venereal  diseases  were 
decreased,  owing  partly  to  a  campaign  of  education  and 
partly  to  the  fact  that  by  act  of  Congress  the  pay  of  those 
afflicted  with  such  diseases  is  stopped  during  period  of  sick- 
ness. Alcoholism  was  the  lowest  in  years.  Malarial  fever 
was  the  lowest  since  1898  when  the  troops  were  first  stationed 
in  the  tropics.  The  report  shows,  however,  that  this  branch 
of  the  service  needs  more  attention.  (404) 

Typhoid  and  Principles  of  Inoculation. — One  of  the  clearest 
expositions  for  the  layman  of  the  principles  underlying  the 
practice  of  immunizing  is  the  second  chapter  of  Major  Lelean's 
book  on  'Sanitation  in  War.'  We  can  do  no  better  than 
sketch  some  of  his  points.  Immunity  may  be  of  three  types — 
acquired,  natural,  and  artificially  acquired.  An  example  of 
the  first  is  afforded  by  those  persons  who  having  had  a  disease, 
such  as  scarlet  fever,  are  immune  to  further  attacks.  Natural 
immunity  consists  in  innate  qualities  or  a  quality  by  virtue 

[43] 


HYGIENE     AND     WAR 

of  which  the  individual  is  not  subject  to  some  particular  infec- 
tious disease.  We  have  artificially  acquired  immunity  where 
vaccine,  etc.,  introduced  into  an  individual's  system  prevents 
disease. 

Immunization  is  based  upon  the  following  considerations: 
(i)  number  of  invading  organisms  (bacteria);  (2)  route  of 
invasions;  cholera  is  virulent  in  the  intestines  but  innocuous 
in  the  blood,  tetanus  is  virulent  in  wounds  but  innocuous  in 
intestines;  (3)  virulence  of  organisms,  e.  g.,  no  case  of  recovery 
from  developed  hydrophobia  Has  been  reported ;  and  (4)  physio- 
logical resistance.  One  should  consult  the  author's  diagrams 
illustrative  of  this  theme,  for  they  tend  to  make  an  obscure 
subject  plain.  As  his  work  is  designed  for  the  benefit  of 
soldiers,  his  way  of  putting  his  data  is  simple  and  convincing. 
The  struggle  of  the  anti-bodies,  etc.,  with  disease  is  compared 
to  a  battle  as  follows : 

The  organisms  (bacteria)  are  the  enemy  invaders.  The  body  is  the 
invaded  country.  The  toxins  are  the  enemy's  projectiles.  The  comple- 
ment is  the  unarmed  population.  The  tissue  cells  are  the  arsenals,  the 
anti-toxins  are  the  defenders'  projectiles;  the  amboceptors,  the  bayonets 
of  the  defenders;  and  the  phagocytes,  the  body  snatchers.  Here  is  the 

Campaign 
ist.    The  Invasion 

The  unarmed  defenders  are  driven  back  by  the  gun-fire  of  the  invaders 
(negative  chemiotaxis  and  toxins).  The  arsenals  of  defenders  are  put  out 
of  service  (toxins  kill  tissue  cells).  Invaders  may  capture  the  lines  of  com- 
munication (the  blood  vessels)  and  reach  the  capital  (heart).  In  this  case, 
surrender  must  follow  (death  of  defender). 

2nd.    Rally 

But  the  invaders'  fire  is  checked  by  defenders  (anti-toxin).  Defenders 
armed  with  bayonets  (amboceptors)  converge  on  the  invaders  (positive 
chemiotaxis). 

3rd.    Battle  Joined 

The  invaders'  fire  is  smothered  (toxins  neutralized).  Defenders  bring 
bayonets  into  play  (complement  and  amboceptors). 

4th.    Victory 

Invaders  penned  and  annihilated  (abscess  cavity).  Dead  of  both  sides 
removed  from  the  body  (organisms  and  complement).  This  is  done  by  the 
body  snatchers  (phagocytes).  Invasion  defeated. 

[44! 


HYGIENE     AND     WAR 

5th.   Permanent  Mobilization  for  Protection 

Defenders  are  now  armed  with  bayonets  never  becoming  obsolete  (per- 
manent amboceptors).  Even  when  the  ammunition  becomes  obsolete  for 
use  of  present  guns  (transient  anti-toxins),  enough  bayonets  remain  to 
enable  defenders  to  crush  any  subsequent  invasion  before  the  enemy 
can  develop  gun-fire  (permanent  immunity  by  bacteriolysis)  before  toxins 
can  do  harm.  (133,  ch.  II.) 

The  process  of  typhoid  inoculation  causes  very  little  incon- 
venience. For  example,  with  a  large  number  vaccinated  it 
was  found  that  but  I  per  1,000  was  incapacitated  for  5  days; 
3  per  1 ,000  were  incapacitated  for  3  days ;  996  per  1 ,000  were 
incapacitated  for  less  than  3  days.  Out  of  27,000  cases  of 
inoculation  among  the  Canadian  troops,  there  was  but  one 
hospital  case  (99  per  cent  of  the  cases  are  usually  able  to 
work  forty-eight  hours  after  the  inoculation).  (396,  201,  4, 
323,  321,  322,  75,  132) 

It  should  be  emphasized  that  though  typhoid  is  water- 
borne,  to  some  extent,  probably  the  most  frequent  method 
of  conveyance  is  direct  carrying  from  excreta,  urine,  etc.,  by 
persons,  flies,  etc.  The  typhus  bacilli  are  said  to  persist  in 
feces  for  three  days,  in  water  drum  3  days  to  three  weeks,  in 
textiles  for  three  months,  and  in  butter  for  four  months.  After 
the  patient  has  recovered,  he  may  remain  a  carrier  for  as 
much  as  four  years  and  perhaps  for  life.  The  remaining  bac- 
teria may  live  in  masses  in  necrotic  patches  of  the  mucosa  of 
the  gall  bladder,  in  such  a  position  that  the  anti-bodies  can- 
not reach  them.  The  bile-salts  neutralize  some  of  the  anti- 
bodies. A  subsequent  diarrhoea  may  then  sweep  vast  quanti- 
ties of  them  free  and  thus  infection  is  made  possible.  Germany 
is  said  to  have  .03  per  cent,  infection  from  contact  carriers, 
the  United  States,  3  per  cent.  One  example  of  infection  is 
afforded  in  the  no  cases  caused  from  eating  pies  made  by 
one  infected  cook.  Six  deaths  resulted.  This  means  careful 
inspection  of  army  cooks.  (193;  434 — bulletins  No.  3,  4,  5,  6) 

Lelean  points  out  the  necessity  of  having  ample  laboratory 
facilities  present  with  each  army  in  the  field.  In  fact,  traveling 
motor  laboratories  now  accompany  the  troops  at  the  front. 
Furthermore,  careful  statistics  should  be  kept  of  sources  of 

[45] 


HYGIENE     AND     WA  R 

infection,  progress  of  diseases,  treatment,  etc.  It  is  well  to 
serve  a  disinfectant  at  night  to  those  suspected  of  having 
typhoid.  Apparatus  for  use  of  the  same  should  be  carried 
with  the  troops.  Suspects  should  bivouac  around  the  medical 
center,  and  equipment  of  troops  in  the  field  should  be  disin- 
fected with  apparatus  now  used  for  such  purposes.  The  stock 
concentrated  disinfectant  used  by  some  of  the  European 
armies  is  Liquor  Cresoli  Saponatus  with  a  carbolic  coefficient 
of  12.  Carbolic  acid  and  formalin  supplied  at  the  rate  of  8 
ounces  to  the  gallon  are  good.  The  following  data  are  impor- 
tant. (133,  Lecture  IV.) 

USUAL  NUMBER  OF  DAYS  OF: 

NAME  OF  DISEASE  Incubation         Segregation 

Cholera 3-6  12 

Chicken-pox 10-16  20 

Diphtheria 2-10  12 

Enteric  fever 10-14  23 

Erysipelas 3-10  12 

Influenza 3~4  5 

Measles 10-14  l6 

Mumps 10-20  24 

Plague 2-8  21 

Scarlet  fever 1-4  10 

Smallpox 12-24  l6 

Typhus 5-14  14 

While  we  have  mentioned  only  typhoid  inoculation  specifi- 
cally, attention  should  be  called  to  the  fact  that  serums,  tuber- 
culins, etc.,  are  given  for  other  infectious  diseases  as  smallpox, 
diphtheria,  scarlet  fever,  typhus,  malarial  fever,  yellow  fever, 
cholera,  meningitis,  etc. 

The  main  sources  of  infection  are  the  sick  man,  air,  water, 
food,  and  insects.  Therefore  isolate  the  sick.  See  that  the 
air,  water,  and  food  are  clean,  pure,  and  wholesome.  Destroy 
the  insects. 

Poison  Gas. — One  of  the  newest  methods  of  waging  warfare 
is  the  employment  of  poisonous  gases,  contained  in  bombs 
exploded  in  the  camp  of  the  enemy  or  in  fumes  wafted  by 
winds  into  their  trenches.  Actual  data  of  what  is  being  used 

[46] 


HYGIENE     AND     WAR 

and  how  are  not  available  at  this  writing.  Chlorine,  sulphur 
dioxide,  and  nitrogen  tetroxide  are  possible  agents.  As  to 
the  probability  whether  it  is  bromine  or  chlorine,  the  latter 
is  the  more  likely  because  of  its  heaviness  and  cheapness.  It 
is  two  and  a  half  times  the  weight  of  air  and  hence  settles 
quickly  into  trenches  when  used.  Various  devices  are  used 
for  protection  from  such  asphyxiation.  A  damp  cloth  placed 
in  the  mouth,  especially  if  a  little  bicarbonate  of  soda  has  been 
put  in  the  water,  accompanied  by  breathing  in  through  the 
mouth  and  out  through  the  nose  will  afford  some  protection. 

(397) 

Air  Sickness,  etc. — Popular  writers  are  referring  to  some 
maladies  attendant  upon  the  employment  of  air  ships  as  air 
sickness.  Whether  there  is  any  real  basis  for  this  designation 
remains  for  the  future  and  further  investigation  to  demon- 
strate. It  is  said  to  be  indicated  by  a  sort  of  "sickly  nausea 
accompanied  by  severe  headache  and  a  violent  desire  to  sleep. 
Swift  descent  through  air  will  bring  on  these  symptoms,  which 
medical  men  say  are  caused  by  blood  circulation  of  the  aviator 
being  unable  to  at  once  adapt  itself  to  rapid  change  of  atmo- 
spheric pressure  caused  by  sudden  drops  in  the  air."  Possi- 
bly we  may  have  new  health  problems  to  solve  in  connection 
with  the  submarine.  (281) 

Gun  Deafness. — Gun  deafness  is  not  peculiar  to  the  present 
war  though  it  is  probable  that  it  will  be  far  more  prevalent 
than  formerly.  Home  attributes  it  to  the  effect  which  very 
loud  noises,  sudden  and  unexpected,  have  upon  the  terminal 
portions  of  the  nerve-structures  of  the  ear.  The  nature  of 
these  injuries  is  such  as  to  render  recovery  doubtful.  The 
drum  of  the  ear  may  even  be  ruptured  (93,  309).  Suzuki 
reports,  "during  firing  (by  ships)  membranes  were  often  rup- 
tured and  there  were  concussions  of  the  labyrinth.  The  list 
of  wounded  included  116,  i.  e.,  7  per  cent.,  with  concussion  of 
labyrinth  or  rupture  and  congestion  of  tympani  membrane." 
The  sudden  condensation  and  rarefaction  of  air  in  the  external 
meatus  is  the  cause,  writes  Home.  One  ear  usually  is  more 
affected  than  the  other.  This  is  also  often  found  to  be  true 

[47] 


HYGIENE     AND     WAR 

among  sportsmen — in  this  case  the  left  ear  in  a  right-handed 
shooter  being  the  one  affected.  However,  this  malady  is  to 
a  large  degree  preventable  by  keeping  ears  as  far  as  possible 
from  the  muzzle  of  the  gun.  It  is  a  good  idea  to  hold  the 
mouth  open  (chew  toothpicks,  etc.,  during  firing).  The  eusta- 
chian  tube  should  be  kept  open.  Suzuki  suggests  that  steril- 
ized cotton  wool  be  placed  in  the  ears.  The  English  admiralty 
found  this  useless.  Various  aural  plugs  have  been  invented 
and  tried.  With  what  degree  of  success,  we  are  not  at  this 
time  able  to  report.  The  characteristics  which  it  will  be 
necessary  for  such  a  piece  of  apparatus  to  have  are : 

(i)  It  must  be  close-fitting  and  impervious,  (2)  must  reduce 
intensity  of  sound,  (3)  must  not  affect  the  hearing,  (4)  must  be 
easy  to  insert  and  remove,  (5)  must  be  non-irritating,  (6)  must 
be  inexpensive,  (7)  must  be  antiseptic. 

The  effect  of  gun-fire  on  the  ear  is  not  directly  proportional 
to  one's  distance  from  the  gun.  Ross  states,  "There  is  a 
probability  that  if  a  man  stands  at  so  short  a  distance  as  D 
from  the  muzzle  of  a  gun  which  discharges  a  projectile  of  a 
weight  W,  his  sense  of  hearing  will  not  be  hurt."  To  illus- 
trate, if  D  is  proportional  to  the  sixth  root  of  W,  and  D  is 
10  feet  for  the  discharge  of  a  64-pound  shot,  what  is  D  for  the 
discharge  of  a  9-pound  shot?  D  equals  Wxk,  k  being  a  con- 
stant in  this  case,  5 :  then  D  equals  7  feet  compared  with  the 
16  for  64  pounds.  (314,  309) 

Cholera  and  Plague. — We  shall  not  trace  the  history  of  the 
terrible  toll  cholera  and  plague  have  demanded  in  peace  and 
war  times.  War  has  ever  served  to  spread  them.  Western 
troops,  invading  the  orient,  have  become  infected  and  have 
scattered  these  diseases  in  their  travels  often  carrying  them  to 
their  home  lands.  Oriental  troops  in  their  invasions  and  mi- 
grations westward  have  produced  like  results.  In  the  present 
war  the  danger  is  from  the  near  east.  Some  cases  are  rumored 
in  Russia.  A  number  of  cases  have  been  found  in  Servia. 
There  may  be  some  in  Greece  and  probably  Turkey  has  many, 
though  facts  relative  to  her  condition  are  absent.  The  plague 
at  the  time  of  report  (1914)  was  present  in  Beirut  and  Leb- 

[48] 


HYGIENE     AND     WAR 

anon,  Jaffa  and  Caiffa,  Tripoli  (Syria),  Smyrna,  Adalia,  Jeddoh, 
Basra  on  the  Tigris  and  in  the  Russian  Steppes.  (221,  265, 
152,  396;  434,  Bulletin  No.  5;  391,  291,  29,  80,  202) 

The  disease  is  easily  spread  in  the  camp  through  dirty  hands 
and  improper  use  of  urinals  and  latrines.  It  is  carried  on  the 
boots,  etc.  This  shows  that  conservancy  must  be  as  nearly 
perfect  as  possible.  It  was  with  great  difficulty  that  the  Bul- 
garian troops  were  made  to  use  the  latrines.  We  have  already 
pointed  out  how  severely  they  suffered  from  cholera  in  their 
war.  Simpson  shows  that  moving  crowds,  water,  cattle,  flies, 
floods,  and  persons  are  modes  of  infection.  Persons  may  be 
carriers  without  themselves  having  the  disease.  It  is  then, 
seen  that  great  care  should  be  used  in  examining,  cleansing 
articles  shipped,  etc.  The  water  supply  should  be  pure.  The 
sick  should  be  isolated.  Inoculation  may  be  tried.  (292,  293, 
290) 

Strickland  has  given  important  data  with  reference  to  the 
incidence  of  plague  in  Europe  and  the  part  played  in  it  by  the 
rat.  He  states  that  both  the  black  and  the  brown  rat  are 
carriers  of  the  flea  which  is  responsible  for  cholera  but  that 
their  different  habits  make  the  black  rat  the  more  serious 
menace.  He  cites  Amsterdam  as  being  infested  with  black 
rats  and  having  numerous  cases  of  the  plague.  In  England, 
the  brown  rat  conquered  and  drove  out  the  black,  and  the 
incidence  of  the  disease  became  almost  nil.  The  black  rat  is 
semi-domesticated,  does  not  fear  man,  and  hence  has  constant 
access  to  him.  The  brown  rat  is  savage  and  shuns  man,  being 
afraid  of  him.  It  lives  in  the  foundation  of  the  house,  if  in  it 
at  all.  It  tends  to  migrate  to  the  country  in  the  summer  and 
thus  lives  in  town  but  half  the  year.  Its  first  preference  is 
the  farm-yard;  its  second,  the  village;  and  its  third,  the  coun- 
try town.  It  is  not  easy  to  find  in  a  large  city.  (227) 

The  author  attributes  the  cessation  of  the  plague  in  London 
to  better  housing  conditions,  whereby  the  rats  were  eradicated 
to  a  large  extent.  Some  of  his  conclusions  are : 

1.  The  black  rat  is  responsible  for  the  great  European  plagues. 

2.  Good  housing  has  forced  the  disappearance  of  the  black  rat. 

[49] 


HYGIENE     AND     WAR 

3.  Upon  this  the  brown  rats  increased. 

4.  The  brown  rat  is  not  an  important  factor  because  of  its  shyness  and 
because  of  its  habits.    It  is  dangerous  only  in  the  winter. 

5.  For  protection  against  the  black  rat,  buildings  should  be  constructed 
of  stone,  etc.,  instead  of  wood. 

6.  For  protection  against  brown  rats,  limit  their  food  supply  or  rather, 
deprive  them  of  any. 

Dysentery  and  Diarrhoea. — Dysentery  and  diarrhoea  are 
ever  present  in  troops  marching,  fighting,  and  encamped. 
During  the  Franco- Prussian  War,  for  example,  there  are  said 
to  have  been  in  one  army  some  40,000  cases  with  2,000  deaths 
resulting.  Sandwich  claims  that  it  is  water-borne.  Among  the 
returned  troops  at  Aldershot  in  1901,  there  were  170  cases  and 
28  deaths.  (299)  The  probability  is  that  such  returning 
troops  spread  the  infection  throughout  the  vicinity  to  which 
they  return.  Extreme  care  in  sanitation  serves  to  protect 
them.  Flies  are  instrumental  in  the  infection.  Refuse  should 
be  taken  care  of  and  food  properly  protected  and  stored.  As 
a  means  of  prophylaxis,  Grober  urges  the  soldier  and  likewise 
the  civilian  to  refrain  from  touching  the  face  with  the  hands 
(as  soldiers  are  likely  to  do  in  smoking),  to  avoid  errors  in 
diet,  and  to  exercise  cleanliness  in  eating.  He  further  suggests 
that  five  drops  of  hydrochloric  acid  in  some  beverage  at  each 
meal  is  good.  (298,  74,  209,  205) 

Tetanus. — This  disease,  ever  present  in  war,  is  demanding 
an  unusual  toll  in  the  present  struggle.  Many  complications 
accompany  it  and  the  literature,  technical  and  otherwise,  is 
voluminous.  Kreuter  has  found  it  frequently  resulting  from 
shrapnel  wounds,  from  men  being  run  over,  or  from  their  being 
kicked  by  a  horse.  In  his  cases  the  cramps  were  restricted 
to  the  region  of  the  injured  parts.  The  disturbances  in  swal- 
lowing manifested  themselves  early.  The  average  mortality 
of  cases  where  the  period  of  incubation  was  less  than  from 
8  to  10  days  was  from  80  to  90  per  cent.  It  was  found  that  if 
anti-toxin  was  administered  within  less  than  10  days  of  incu- 
bation the  mortality  was  lessened  from  95  to  73  per  cent.,  where 
given  in  cases  of  longer  incubation,  from  40  to  70  per  cent. 
,  319,  7i,  127) 

[50] 


HYGIENE     AND     WAR 

Mental  Troubles. — Oppenheim  claims  that  neurological  ail- 
ments furnish  a  large  contingent  of  the  morbidity  due  to  war. 
The  hardships,  etc.,  frequently  give  rise  to  psychoses  and 
neuroses.  However,  he  finds  that  such  ailments  occur  for  the 
most  part  in  those  already  predisposed.  A  fact  of  interest  to 
psychologists,  especially  to  those  of  the  Freudian  school,  is 
that  dreams  of  the  soldiers  partake  largely  of  war  content. 
In  cases  of  mild  epilepsy,  the  number  of  attacks  may  be 
increased  by  war.  (434,  Bulletin  No.  5;  144,  192,  160,  308, 
162,  309,  24,  217,  180,  183,  312,  307,  311) 

Mendel  finds  that  the  alcoholic  cases  (chronic)  are 
the  least  amenable  to  discipline  and  that  the  nature 
of  their  offenses  is  a  lack  of  respect  for  their  superior 
officers.  (154) 

One  writer  states  that  preceding  the  outbreak  of  a  war 
there  is  an  increase  in  the  number  of  nervous  troubles  which 
continue  throughout  the  war's  duration  and  manifest  them- 
selves for  some  years  after  its  close.  For  this  reason  it  is  neces- 
sary to  exercise  great  care  in  the  selection  of  men,  especially 
sailors.  It  has  been  pointed  out  by  others  that  in  the  present 
conflict,  though  the  nervous  troubles,  derangement  of  the 
mind,  etc.,  are  frequent,  the  recoveries  so  far  have  been  rapid. 
It  should  be  remembered  that  in  the  midst  of  such  times,  data 
are  hard  to  obtain,  and  as  yet  no  conclusions  can  be  announced 
relative  to  these  points.  (315,  305) 

So  far  no  scientific  studies  have  been  made  of  the  effect  of 
war  on  the  minds  of  officers  and  men.  Some  authors  have 
pointed  out  particular  battles  in  which  it  seemed  to  them  the 
losing  general  was  himself  the  cause  of  his  defeat,  owing  to 
the  early  stages  of  paresis  having  set  in.  Many  desertions 
are  probably  due  to  dementia  praecox.  The  facts  show  that 
mental  disease  is  an  important  problem.  One-fifth  of  the 
discharges  is  said  to  be  due  to  them.  In  1912,  out  of  1,062 
discharged  from  the  United  States  Army,  200  were  incapaci- 
tated by  mental  diseases.  This  does  not  include  the  neuras^ 
thenic  and  hysterical  cases.  Dementia  praecox  gives  about 
56  per  cent,  of  the  cases.  (306,  316,  313,  40) 

[51] 


HYGIENE     AND     WAR 

After  calling  attention  to  the  frequency  of  hysteria,  trau- 
matic and  otherwise,  which  is  increasing  in  this  war,  another 
writer  points  out  the  important  role  played  by  auto-sugges- 
tion. He  cites  specific  cases:  (i)  one  man  had  his  back  hurt 
through  the  fall  of  a  wooden  sleeper  and  palsy  of  left  leg 
resulted,  the  indication  being  that  the  trouble  was  purely 
psychical;  (2)  another  who  was  leaning  his  shoulder  on  a 
parapet  near  which  an  explosion  occurred,  developed  hysterical 
symptoms,  although  there  were  no  discoverable  lesions  respon- 
sible for  them;  (3)  another  case  was  that  of  a  lieutenant 
troubled  with  dysentery  who  became  paraplegic ;  (4)  an  officer 
who  had  carried  a  wounded  man  from  the  danger  zone,  became 
weak  in  his  right  arm  and  foot  three  days  after  and  had  hysteri- 
cal symptoms.  The  patient  had  seemed  healthy  prior  to  the 
accident.  But  many  factors  are  at  work  besides  the  mere 
accident,  such,  for  example,  as  fatigue,  hunger,  sense  of  respon- 
sibility, strained  attention  of  particular  organs,  concussion  of 
explosions,  etc.  He  finds  traumatic  hysteria  more  frequent 
than  traumatic  neurasthenia.  He  also  states  that  the  emotions 
seem  to  play  a  part  in  the  development  of  hysteria.  (310,  307) 

Some  of  Weyandt's  suggestions  and  data  are  as  follows: 
Get  the  patient  away  from  the  scene  of  his  trouble  as  soon  as 
possible.  Quiet  him,  using  narcotics,  even  the  strait-jacket,  if 
necessary.  Quietness  is  essential.  He  finds  no  particular  war 
psychoses.  But  those  predisposed  are  quite  liable  to  be  thrown 
by  the  stress  of  conflict  into  well-marked  cases.  Epileptics, 
those  with  slight  imbecility,  those  with  manic-depressive  or 
catatonic  attacks,  those  with  syphilitic  brain  or  spinal  cord 
troubles,  are  very  suspectible.  He,  also,  urges  that  we  avoid 
'mass  psychosis'  by  the  immediate  removal  of  a  patient  from 
the  scene.  It  was  found  that  in  the  Franco-Prussian  War  the 
psychoses  of  the  Germans  were  0.54  per  thousand;  of  the 
United  States  troops  in  the  Spanish- American  War,  2.7  per 
thousand;  of  the  British  in  Boer  War,  2.6;  of  the  Russians  in 
the  Russo-Japanese  War,  2.0;  of  the  Bulgarians,  0.33;  Monte- 
negrins, 0.25;  Servians,  0.25;  and  Greeks,  0.097  in  the  late 
war;  while  among  the  Germans  in  their  South  African  expedi- 

[52] 


HYGIENE     AND     WAR 

tion  it  was  4.95,  and  including  epilepsy  and  hysteria,  8.28 
per  thousand.  Heat  stroke  and  concussion  of  the  brain  require 
complete  rest  and  quiet  at  once.  (248,  154,  31,  311) 

Venereal  Diseases. — Keefer  claims  that  these  diseases  still 
constitute  the  big  problem  of  the  army  causing  more  trouble 
than  any  others.  He  states  that  it  is  claimed  the  United  States 
army  suffers  more  from  these  than  any  foreign  army.  Facts 
are  not  numerous  and  exaggeration  is  apt  to  occur.  Up 
to  the  eighteenth  century  almost  an  army  of  prostitutes 
accompanied  the  warriors  and  indeed  in  some  cases  their 
number  exceeded  that  of  the  soldiers.  With  the  dawn  of 
compulsory  military  systems  this  was  altered,  but  hordes 
followed  Napoleon's  troops  according  to  Blaschko  (23).  He 
points  out  that  the  men  left  in  charge  of  a  conquered  city  are 
especially  exposed  as  brothels  are  still  maintained  in  some. 
He  finds  the  number  of  recently  acquired  cases  and  reservists 
sent  back  for  treatment  larger  than  is  generally  supposed. 
In  the  last  half  of  the  Franco-Prussian  War,  9  per  cent,  of 
morbidity  was  due  to  these  diseases.  He  says  "Absolute 
prohibition  of  public  dances,  and  the  early  or  total  closing  of 
saloons  will  help  .  .  .  Weed  out  any  loose  women  that  may 
attach  themselves  to  the  army  in  the  guise  of  nurses,  etc. 
Do  this  especially  at  the  bases."  He  would  have  intercourse 
with  prostitutes  prohibited,  even  made  a  crime,  and  urges 
that  "keeping  secret  a  beginning  venereal  disease  justifies 
punishment."  It  is  for  the  government  to  take  care  of  the 
class  of  women  thus  deprived  of  their  means  of  livelihood. 

An  English  medical  writer  states  that  the  gonorrhoea  found 
among  the  present  English  troops  is  acquired  in  most  cases 
in  their  new  environment  after  enlistment.  One  of  the  agents 
instrumental  in  the  spread  of  this  disease,  he  says,  is  gratui- 
tous alcohol,  i.e.,  the  habit  of  treating.  In  all  cases,  early 
treatment  at  a  home  camp  is  desirable.  It  will  take  six  weeks 
of  treatment  before  the  recruit  can  be  considered  safe  and 
sound.  There  should  be  instruction  on  these  subjects  by  the 
medical  corps.  Temperance  has  had  an  excellent  effect.  Out 
of  some  36,000  troops  examined  but  one  case  of  gonorrhoea 

[53] 


HYGIENE     AND     WAR 

was  found.  In  fact,  such  numbers  as  are  available  seem  to 
lead  to  the  conclusion  that  the  extent  of  these  diseases  has 
been  overestimated.  (300,  30,  163) 

Bruck  found  venereal  diseases  transmitted  through  free  pros- 
titution. The  officers  in  his  region  were  detailed  to  stop  this. 
The  lewd  women  were  found  in  saloons,  cheap  restaurants, 
and  resorts  of  kindred  character.  The  officer  worked  in  con- 
junction with  a  French  policeman  under  the  direction  of  a 
staff  officer.  The  men  were  finally  led  to  point  out  certain 
diseased  women  who  were  then  detained  and  interned  for 
treatment.  This  frightened  them  as  a  class  and  infections 
became  reduced  to  the  normal  number.  Of  numerous  women 
examined,  only  a  portion  had  clinical  gonorrhoea.  However, 
the  microscope  revealed  much  more  infection.  The  results 
show  that  the  bacilli  may  exist  as  saprophytes  in  the  external 
genital  organs  of  the  female.  (30) 

Keefer  offers  the  following  suggestions  by  way  of  prevention : 
(116) 

1.  Isolate  the  infected. 

2.  Make  it  a  crime  for  a  diseased  male  to  spread  the  disease. 

A  plan  of  the  United  States  army  involves  the  following:- 

1.  Enlisted  men  are  to  be  physically  inspected  twice  a  month  for  detec- 
tion of  venereal  diseases. 

2.  The  exposed  soldier  must  report  for  cleansing  and  preventive  treat- 
ment immediately  upon  return  to  camp  or  garrison. 

3.  Any  soldier  who  fails  to  report  when  he  is  suffering  from  these  diseases 
is  to  be  court-martialed  for  neglect  of  duty. 

4.  Afflicted  must  stay  in  post  while  affected. 

5.  Officers  shall  attempt  to  give  suitable  games,  exercises,  etc.,  to  occupy 
time  of  men  properly. 

6.  Officers  shall  point  out  the  tremendous  importance  of  this  disease. 

7.  By  act  of  Congress,  those  absent  from  duty  owing  to  venereal  diseases 
or  alcohol  do  not  receive  pay  during  such  time. 

As  indicated  in  our  introduction,  the  work  done  in  Vera 
Cruz  indicates  that  instruction  in  prophylaxis  helped  and 
hence  should  be  given.  (331,  434,  Bulletin  No.  3;  50) 

Feet. — Not  only  are  soldiers  incapacitated  for  their  duty  by 
disease  and  wounds,  but  many  are  rendered  a  burden  to 

[54] 


HYGIENE     AND     WAR 

society  through  crippling  of  the  feet.  From  what  has  already 
been  said,  the  importance  of  strong,  sound  feet  is  probably 
apparent.  How  significant  is  the  r61e  played  by  them,  not 
only  in  marching  and  running  but  in  every-day  work,  has  not 
been  observed  by  the  general  public  as  much  as  it  should  be. 
Physicians  have  for  years  been  pointing  out  that  the  im- 
proper shoe  is  responsible  for  nervous  troubles,  and  disorders 
of  the  visceral  organs,  as  well  as  foot  pain.  The  army  authori- 
ties therefore  do  well  to  insist  on  the  proper  fitting  of  the 
proper  kind  of  shoe.  But  careful  attention  should  also  be 
given  to  the  socks  of  those  who  are  to  march  or  use  the  feet 
much.  Keefer  claims  that  light  woolen  socks  are  best  for 
marching.  Many  of  the  English  troops  aim  to  have  shoes 
of  such  size  that  two  pairs  of  socks  can  be  worn  with  ease. 
Thereby  the  friction  is  reduced  and  warmth  is  increased. 
German  soldiers  wrap  triangular  oil-soaked  cloths  about  their 
feet  in  lieu  of  socks.  A  British  expert  states  that  the  life 
of  the  sock  furnished  their  soldiers  is  about  60  to  70  miles 
marching.  Socks  should  be  changed  and  washed  daily  if 
possible.  Dirt  promotes  friction  and  if  washing  is  impossible, 
they  should  be  dried  and  thoroughly  rubbed.  (116,  133) 

Keefer  gives  the  following  directions  for  fitting  shoes.  The 
individual  should  stand  on  a  scale  board,  flat  footed,  with  a 
weight  of  40  pounds  on  his  person.  The  length  of  foot  is  read 
from  the  board.  Measure  the  distance  around  the  ball  of  the 
foot  at  the  base  of  the  toes  and  add  2  to  the  scale  length.  A 
table  is  furnished  for  widths.  For  example,  a  foot  measuring 
6J/2  width  and  9>£  size,  requires  an  8>2  D  shoe.  Always  lace 
the  shoe  to  the  top  in  trying  on.  There  should  be  at  least 
^  of  an  inch  beyond  the  big  toe.  (116) 

Lelean  states  that  foot  troubles  arise  from  insufficient  space 
(vertical)  for  the  toes  and  from  lack  of  sufficient  curvature  at 
the  heel  (back).  (133,  ch  I.) 

Frost-Bite  Trench  Feet. — So-called  frost-bite  has  caused  a  great 
deal  of  trouble  in  the  present  as  in  former  years,  though  not 
so  well  recognized  then.  In  January  (1915)  two  brigades  of 
English  infantry  were  out  of  action  because  of  it.  The  term 

[55] 


HYGIENE     AND     WA  R 

is  a  wrong  one,  for  low  temperature  is  not  the  cause.  The 
trouble  arises  from  prolonged  contact  with  moisture  or  cold 
water — such  as  men  in  the  trenches  and  those  operating  in 
lowlands  and  marshes  have  been  subjected  to. 

It  is  often  combined  with  superficial  areas  of  gangrene 
started  by  interference  with  the  circulation.  In  the  Crimean 
War,  there  were  among  the  allies  some  1,924  cases  of  such 
'frost-bite'  with  456  deaths  in  the  year  1854-1855,  while  in 
1855-1856  there  were  but  474  cases  with  6  deaths.  The  tempera- 
ture for  the  two  years  was  about  the  same,  but  in  the  former 
year  the  trenches  were  flooded,  the  clothes  were  dripping,  the 
tents  leaked,  and  wet  blankets  were  used.  This  was  remedied 
in  the  year  following,  with  the  results  given.  (133,  187,  47, 

332,  333,  334>  335) 

Lelean  points  out  that  approximately  25  per  cent,  of  troops 
suffer  during  the  first  ten  days  of  a  campaign  from  foot 
troubles.  During  the  early  part  of  the  Franco-Prussian  War 
some  30,000  men  were  incapacitated  in  the  German  army 
through  foot  troubles.  Improperly  clad  and  sore  feet  may 
increase  by  20  per  cent,  the  amount  of  work  necessary  to  be 
done,  and  by  thus  raising  the  temperature,  absorb  two-thirds 
of  the  margin  between  optimum  and  pathological  heat.  (133, 
ch.  Ill,  332) 

He  finds  that  many  ailments  are  due  not  to  shoes,  but  to 
defects  in  socks  such  as  holes,  ridges,  and  poor  darning.  These 
may  cause  such  pressure  that  the  circulation  is  impeded,  thus 
affording  opportunity  for  the  development  of  gangrene.  Of 
the  two  pairs  of  socks  advised  to  be  worn,  he  suggests  that 
the  inner  be  woolen  and  the  outer — that  next  the  shoe — cotton. 
Even  thin  greased  or  oiled  paper  may  be  substituted  for  socks. 
Upon  arriving  at  camp,  the  soldier  should  clean,  dry,  and  'dub- 
bin' (rub  with  some  form  of  tallow  or  grease)  his  shoes  to  keep 
them  water-proof  and  pliable.  If  the  feet  are  soft,  it  is  well  to 
wash  them  in  cold  water  and  rub  them  well  with  alum  or  spirit 
lotion.  If  washing  with  water  is  impossible,  rub  thoroughly 
with  coarse  cloths  or  with  the  hands.  Put  on  clean  socks  and 
shoes  for  camp.  It -is  a  good  plan  to  soap  the  insides  of  socks 

[56] 


HYGIENE     AND     WAR 

if  much  troubled.  Talc  powder  is  good.  In  case  of  blisters, 
puncture  with  sterile  needle  and  paint  with  iodine.  Corns 
should  be  taken  care  of  by  the  regimental  chiropodist.  For 
bromidrosis  (fetid  perspiration)  soak  the  feet  on  alternate 
days  in  a  2  per  cent,  solution  of  formalin  or  apply  2  per  cent, 
salicylic  acid  ointment. 

Miller,  from  his  observation  of  376  cases  of  'frost-bite',  dis- 
covered that  there  was  freezing  at  the  time  in  65  cases  out  of 
100,  that  all  were  wearing  short  boots  with  more  than  one 
pair  of  socks,  and  most  of  them  wearing  puttees;  that  there 
was  a  change  in  the  color  of  the  feet  to  red-blue  and  black 
noticed  by  the  patients  in  58  per  cent,  of  the  cases,  paleness 
in  42;  numbness,  23;  pain,  9;  and  swelling,  10.  They  had 
been  standing  in  mud  or  water  and  mud.  (156) 

Mayo-Robson  points  out  that  gangrene  often  follows,  owing 
to  the  arterial  blood  supply  being  shut  off.  Tissues  die  as  a 
result.  In  case  of  afflictions  of  this  nature  'frost-bite'  or 
'trench  feet' — he  advises  as  follows:  friction  with  snow  or 
cold  water  in  a  cold  room  whose  temperature  is  gradually  in- 
creased ;  friction  with  oil  of  turpentine,  or  spirits,.with  soap  and 
liniment  (useful  in  the  early  stages).  Raise  the  limb  after 
treatment,  let  it  have  no  constriction,  swathe  it  in  cotton- 
wool, keep  dry  and  sterile.  (196) 

Owing  to  the  relatively  small  number  who  develop  gangrene 
(according  to  his  data)  he  thinks  it  possible  practically  to 
prevent  it  in  this  connection.  He  urges  the  soldiers  not  to 
impede  circulation  by  tight  foot-wear,  and  to  avoid  inadequate 
covering.  As  the  cause  is  standing  in  melting  snow,  the  boots 
should  be  water-proofed. 

One  of  the  English  army  orders  suggests  the  following: 
Frost-bite  is  liable  to  occur  (i)  when  boots  and  puttees  are 
too  tight;  (2)  when  the  general  circulation  throughout  the 
body  is  less  than  normal ;  and  (3)  when  socks,  boots,  and  puttees 
are  wet.  The  best  precautions  are  (i)  boots  should  not  fit 
too  tightly,  but  should  be  at  least  a  size  too  large.  When  boots 
are  worn,  it  is  well  to  wear  two  pairs  of  socks,  although  this  is 
dangerous  if  the  boots  are  small  as  it  leads  to  pressure  on  the 

[57] 


HYGIENE     AND     WAR 

foot.  Puttees  should  never  be  applied  tightly.  (2)  The  general 
circulation  can  best  be  kept  up  by  keeping  the  body  dry  and 
warm;  a  mackintosh  sheet  worn  over  the  great  coat  is  of 
assistance  where  no  water-proof  is  available.  Officers  should 
see  that  dry  standing  is  provided  in  the  trenches  whenever 
possible  by  means  of  drainage,  raising  the  foot-level  by  fas- 
cines of  brush  wood  or  straw  with  boards  on  top,  or  by  the 
use  of  pumps  where  these  are  available.  (196,  334) 

Temoin  finds  many  cases  of  foot  trouble  in  the  French  army, 
and  also  that  the  toes  are  attacked — gangrene  setting  in 
and  the  toes  'dropping  off'.  He  states  that  local  nutrition 
(regulated  of  course  to  a  large  extent  by  the  circulation)  is  a 
leading  cause.  He  suggests  that  soldiers  can  help  avoid  the 
trouble  by  removing  the  shoes  once  or  twice  a  day  or  more,  if 
possible.  (231) 

Though  repeating  somewhat  matter  previously  given,  we 
present  the  following  suggestions  of  another  medical  officer. 
Boots  should  fit  with  comfort,  not  too  tight  nor  too  loose — 
friction  should  be  avoided ;  soften  the  leather  with  'dubbin'  or 
oil ;  remove  the  nails  or  seams  inside  shoe ;  the  socks  should  fit 
properly  (dirty,  badly  darned,  holed,  or  very  thin  socks  are 
not  good);  lace  the  boot  properly.  Wash  and  dry  the  feet 
thoroughly  each  day;  it  is  a  good  plan  to  soak  the  feet  in  a 
bucket  of  water  (cold)  to  which  has  been  added  a  little  per- 
manganate of  potash,  alum  powder,  salt  or  saltpeter.  Let 
out  the  serum  of  blisters  with  a  clean  needle — sterilized  by 
passing  through  a  match  flame — do  not  remove  the  superficial 
layer  of  skin;  treat  sores  with  boracic  lint  or  powder,  a  small 
piece  of  lint  being  wrapped  over  the  sore  and  renewed  daily; 
corns  and  hard  skin  may  be  removed  by  applying  a  few  drops 
of  salicle  collodion  for  three  nights  and  then  after  bathing  in 
hot  water,  peeling  off  the  hard  portion.  (108,  333) 

For  sore  feet  a  Red  Cross  leaflet  advises  the  following: 

1.  Wash  the  feet  with  soap  and  water.    Dry  gently,  but  do  not  rub. 

2.  Dab  with  methylated  spirit  on  cotton- wool  except  where  skin  is 
broken. 

3.  When  dry,  dust  with  powder  composed  of  equal  parts  of  starch  and 
boracic  powder  or  fuller's  earth. 

[58] 


HYGIENE     AND     WAR 

4.  Bandage  with  clean  bandages,  preferably  of  demette,  not  too  tight; 
or  else  put  on  clean  socks. 

5.  Reddened  skin  or  recent  blisters  should  be  protected  by  strips  of 
strapping. 

6.  All  corns  should  be  protected  by  strippings.    Open  sores  require  sur- 
gical advice  and  this  should  be  sought  whenever  possible,  especially  if  the 
surrounding  redness  of  the  foot  is  extending. 

7.  Toe  nails  should  be  cut  short. 

8.  Hard  boots  should  be  well  greased — mutton  fat  is  best.    They  should 
be  well  dusted  inside  with  starch  and  boracic  powder.    (335) 

These  complaints  tend  to  disappear  with  the  approach  of 
spring.  (332) 

Protection  from  Cold. — As  an  indication  of  methods  success- 
fully employed  by  the  Japanese  in  Manchuria  during  the  Russo- 
Japanese  War,  the  following  extract  is  taken  from  a  German 
translation  of  a  Japanese  work  describing  their  methods. 

Every  man  had  an  extra  pair  of  boots,  mittens  and  foot  cloths  to  change 
at  night.  They  were  made  to  eat  often  to  keep  awake  those  inclined  to 
drop  asleep  on  the  march  or  in  changing  guards.  They  were  kept  from 
doing  exercise  that  would  make  them  sweat  and  they  were  not  allowed  to 
lie  down  in  the  snow.  When  straw  was  unavailable,  they  had  to  shovel 
the  snow  away  so  as  to  lie  on  the  ground.  The  clothes  and  shoes  were  made 
larger  for  winter  than  summer  wear  to  allow  for  layers  of  air.  The  button 
holes  and  other  openings  were  protected  with  special  care  after  small  frozen 
areas  corresponding  to  the  button  holes  had  been  found  on  the  chests  of 
some  of  the  soldiers.  The  fingers  and  feet  were  rubbed  with  tallow  or  other 
unsalted  fat  and  mittens  were  worn  over  gloves.  The  mittens  were  some- 
times packed  with  straw  or  feathers  and  the  shoes  with  horse  bedding.  Fur 
keeps  out  the  wind  better  than  woolen  and  a  fur  abdominal  bandage  proved 
a  great  help  in  extremely  cold  weather.  Flannel  suspensories  were  found 
indispensable  at  the  latrines.  Muffs  of  fur  or  felt  and  wristlets  of  fur  or 
wool  were  highly  recommended.  Whenever  the  hands  were  frozen,  it  was 
learned  that  the  men  had  been  wearing  knitted  gloves.  The  foot  cloth 
worn  instead  of  socks  can  be  dried  in  emergency  by  wearing  it  next  the 
body.  Wrapping  the  toes  in  paper,  or  the  whole  foot  in  a  pig  bladder,  was 
also  found  useful  at  times.  Battalions  were  provided  'with  flint  and  steel 
for  starting  fire  when  matches  were  lacking  or  too  damp.  (279) 

VERMIN 

This  subject  is  of  great  importance,  not  only  because  of 
the  inconvenience  caused  by  insects  but  also  because  of  the 
disease-developing  and  disease-carrying  power  of  many.  Ship- 

[59] 


HYGIENE     AND     WAR 


ley  has  rightly  designated  them  'the  minor  horrors  of  war'. 
They  have  already  (1915)  become  a  fierce  pest  among  the 
troops  in  the  western  field  and  the  problems  of  their  control 
and  eradication  are  large.  (220,  440) 

Of  those  giving  trouble,  Major  Lelean  presents  the  follow- 
ing outline:  (133,  pi.  34)  Sanitation  in  War. 

B.  Apterous  Ecto- Parasites  (wingless  insects,  breathing 
thru  stigmata  which  may  be  closed  by  oil  thus  stifling  them). 


PHYLUM 
Class 

Orders 
Families 


ARTHROPODA 


Insecta 


Siphonaptera 

Pulicidae 
(fleas) 


I 
Hemiptera 

!. 

Cimicidae 
(bugs) 


Anopleura 

.  I. 

Pediculidae 
(lice) 


Genera          Xenopsylla         Pulex  Cimex        Pediculus       Phthirius 

I         ,  j          I  I .       .  I  . 

Species          X.  cheopis     P.  irritans  C.  lectuarius  P.  capitis     P.  inguinalis 

P.  vestimenti 
(rat  flea)     (human  flea)     (bed-bug)        (lice)        (crab-louse) 

Part  Played  by  Some  Insects. — In  a  brief  resume,  it  is  impossi- 
ble to  cover  all  the  details  of  the  part  played  by  each  insect. 
For  this  reason  we  shall  call  attention  to  the  known  and  prob- 
able part  played  by  the  more  conspicuous.  Hewitt  has  given 
an  excellent  little  treatise  on  the  house-fly  showing  its  habits, 
etc.,  and  the  significant  part  it  plays  in  typhoid,  and  possibly 
in  anthrax,  gangrene,  and  tuberculosis  (89).  At  the  present 
time  investigations  are  in  progress  which  seem  to  indicate 
that  the  stable-fly  may  be  a  carrier  of  meningitis. 

Lice  not  only  prove  a  source  of  irritation,  thus  diminishing 

I     efficiency,  but  also  have  been  connected  with  the  transmission 

of  typhus  and  relapsing  fever.     Their  continued  operation 

weakens  their  host,  interferes  with  sleep,  and  provokes  a  degree 

of  psychic  disgust  which  causes  more  fear  than  bullets.     In 

[60] 


HYGIENE     AND     WA  R 

this  connection  Shipley's  quotation  of  the  soldier  in  the  South 
African  War  seems  apropos.  "We  strip  and  picks  'em  off  and 
places  'em  in  the  sun  and  that  kind  o'  breaks  the  little  beggars' 
hearts."  He  suggests  the  following  method  of  guarding  against 
them:  (220,  ch.  I) 

1.  Search  clothing  as  often  as  possible  for  traces  of  them. 

2.  Try  not  to  sleep  where  unclean  persons,  especially  affected  ones, 
have  been. 

3.  Change  clothing  as  often  as  practicable.     Lice  will  die  in  unused 
clothes,  usually  within  a  week.    Change  at  night  and  isolate  clothing.    Keep 
infected  clothing  segregated. 

4.  Burn  verminous  clothing  for  which  there  is  no  further  use. 

5.  Lice  on  the  person  may  be  destroyed  by  application  of  petrol,  paraffin 
oil,  turpentine,  xylol,  or  benzine.    Beware  of  fire  or  blaze  after  applying. 
Soap  and  wash  the  head  within  twenty-four  hours  after  application  if 
possible.    Repeat  two  or  more  days  if  necessary.    Use  fine  comb.    Tobacco 
extract  has  been  recommended  by  some.    Scald  underclothing  about  once 
every  ten  days.    Turn  the  clothes  inside  out.     Subject  to  heat  or  jet  of 
steam,  especially  along  the  seams.    A  hot  flatiron  is  good.    Get  rid  of  them 
somehow. 

6.  Avoid  scratching. 

7.  Instruct  privates  along  this  line. 

Bubonic  and  cholera  are  taken  from  fleas  carried  by  rats. 

Button  thinks  lice  are  also  agents  in  transmission  of  enteric. 

Diseases  of  the  intestinal  tract  are  often  caused  by  moths 
contained  in  the  army  biscuits. 

Reed  has  pointed  out  the  part  played  by  mosquitoes  in 
yellow  and  malarial  fevers.  (193,  434,  Bui.  Nos.  4  and  6) 

Itch  mites,  chiggers  (red  bugs),  ticks,  leeches,  etc.,  through 
their  habits  in  connection  with  their  hosts,  cause  irritation, 
and  this  in  turn  causes  scratching.  The  surface  thus  exposed 
gives  ample  opportunity  for  infection. 

The  blood-sucking  insects,  such  as  the  bed-bug,  are  agents 
in  the  spread  of  relapsing  fever. 

Protective  Measures. — Lelean  has  based  his  work  upon  war 
conditions.  Hence  his  suggestions  for  protection  against  these 
organisms  are  valuable. 

In  the  case  of  the  fly,  use  all  the  means  that  have  been  urged 
in  times  of  peace.  Where  there  are  large  bodies  of  troops  and 

[61] 


HYGIENE     AND     WA  R 

especially  cavalry,  the  excreta  must  be  well  taken  care  of — 
incinerated  if  possible.  They  should  not  be  allowed  to  accumu- 
late. Burial  of  excreta  is  not  absolute  protection.  The  pits, 
latrines,  cess-pools,  etc.,  should  be  treated  with  insecticides. 
Camphor  plus  phenol,  4  ounces  to  the  1,000  feet,  is  good. 
Protect  food  from  flies. 

A  good  anti-vermin  product  consists  of  kerosene  and  olive 
oil  in  equal  parts.  A  solution  of  10  per  cent,  acetic  acid  com- 
bined with  the  use  of  a  fine- tooth  comb  is  good.  Kerosene 
and  all  the  volatile  hydrocarbons  applied  neat,  4  per  cent. 
formalin  solution,  ammoniated  mercury  ointment,  5  per  cent, 
solution  of  mercury  in  ether,  will  prove  useful  against  various 
vermin.  The  Germans  shave  the  head. 

For  body-lice  steam  sterilization  is  good.  Fill  the  seams  of 
the  clothes  with  grease,  soap,  and  crude  oil,  etc.  An  emulsion 
of  ]/2  per  cent,  lysol  and  20  per  cent,  soap  to  lather  the  body  is 
excellent.  Here  are  some  dusting  powders  suggested:  2  per 
cent,  iodoform,  2  per  cent,  creosote,  96  per  cent,  naphthalene; 
or  ammoniated  mercury  I  ounce,  zinc  y-t  ounce,  magnesium 
silicate  ^2  ounce.  Powder  black  hellebore  root  with  30  per 
cent,  borax;  powdered  sulphur  in  the  clothing.  Give  the  gar- 
ments a  hot  ironing.  Treat  the  crab-louse  with  mercury 
ointment. 

For  human  fleas  use  pyrethrum  powder,  sprinkle  iodoform. 
Burn  earthen  floors.  Use  an  emulsion  of  5  per  cent,  cresol; 
20  per  cent,  soft  soap  on  other  floors. 

Treat  bed-bugs  with  pyrethrum  powder,  sulphur  dioxide, 
phenol  and  camphor,  or  hydrocyanic  acid. 

Copeman  points  out  the  necessity  of  having  change  of  gar- 
ments, especially  of  shirts  and  underclothes.  The  infested 
individual  should  bathe  and  also  the  inmates  of  his  tent  at 
the  same  time.  Dry-lather  the  bodies  with  cresol-soap  solu- 
tion especially  the  hairy  parts  and  allow  the  lather  to  dry  on 
the  body.  Wash  the  shirts  in  the  solution  of  the  same  made 
in  hot  water.  Turn  the  tunics  and  trousers  inside  out  and 
rub  with  lather,  especially  the  seams.  Let  this  dry  in  the  gar- 
ments. One  may  also  dust  flowers  of  sulphur  in  the  clothing.  (41) 

[62] 


HYGIENE   AND    WAR 

WOUNDS 

General  Statistics. — Keefer  gives  the  following  estimate  of 
casualties  in  battle.  It  is  presumed  that  there  will  be  a  loss 
of  12  per  cent.;  that  of  100  men  hit,  there  will  be  one  dead  to 
each  four  wounded ;  that : 

20  will  be  killed  The  head  and  neck  will  be  wounded 

15  require  transportation  lying  down       in  16  per  cent,  of  cases 
35  require  transportation  sitting  up     Trunk  will  be  wounded  in  30  percent. 
5  will  be  too  wounded  for  transporta-       of  cases 

tion  Upper  extremities  will  be  wounded  in 

25  will  be  able  to  walk  26  per  cent,  of  cases 

Lower  extremities  will  be  wounded  in 
28  per  cent,  of  cases 

He  states  that  84  per  cent,  of  wounds  will  be  caused  by 
rifle,  14  per  cent,  shells  (shrapnel),  I  per  cent,  by  bayonets, 
I  per  cent,  by  lance  and  saber.  This  was  in  1914.  But  the 
developments  of  the  war  have  forced  a  revision  of  these  figures, 
for  in  the  Bulgarian  and  the  present  war,  the  shrapnel  and 
shell  wounds  form  by  far  the  larger  percentage  of  injuries. 

Trial  and  Error  Method. — We  can  not  go  into  a  detailed 
discussion  of  the  treatment  of  wounds  in  war,  for  the  subject 
is  too  technical  and  too  large  for  our  handling.  The  treatment 
of  wounds  now  is  a  problem  largely  of  surgery — not  of  medi- 
cine. And  here  the  skill  and  science  of  peace  times  is  put  to 
service  and  taxed  to  the  limit.  Perhaps  the  large  number  of 
cases,  the  variety  of  the  wounds,  etc.,  allow  of  a  certain 
amount  of  empirical  investigation  which  would  not  be  toler- 
ated in  peace  times  and  from  this  we  may  profit.  We  have 
advanced  so  far  that  we  are  now  able  not  only  to  rescue  many 
who  formerly  would  have  perished,  but  are  even  able  to 
return  them  to  active  service  within  remarkably  short  periods 
of  time.  A  popular  article  quoted  the  following  as  coming 
from  Berlin: 

Eight  hundred  and  eighty-eight  of  every  1,000  wounded  soldiers  brought 
into  German  military  hospitals  not  in  the  war  zone,  in  August,  1914,  were 
discharged  fit  for  service  and  30  of  the  remainder  died.  In  April,  the  number 
restored  to  duty  had  risen  to  912  per  1,000  and  the  deaths  had  fallen  to  14. 
With  the  single  exception  of  March,  the  death  rate  showed  a  steady  decrease, 


HYGIENE     AND     WAR 

and  the  average  for  the  nine  months  from  August  to  April  inclusive  was 
but  1.9  per  cent.  The  percentage  of  those  discharged  fit  for  duty  shows 
an  average  of  88.5  per  cent. 

In  the  Crimean  War,  28  per  cent,  of  the  wounded  died ;  in 
the  Italian  War  of  1859,  17  per  cent.;  of  the  Prussians,  in  the 
war  with  Denmark,  15.5  percent.;  in  1870-1871,  n.i  percent.; 
in  the  Russo-Japanese  War,  6.8  per  cent.  Japanese  and  3.2  per 
cent.  Russians.  (460) 

Fatalities. — The  Lancet,  as  reported  in  July  (1915),  when 
discussing  the  Prime  Minister's  report  on  casualties  to  the 
House  of  Commons,  said : 

Of  the  total  losses  in  the  army,  the  killed  numbered  3,327  officers  and 
47,015  non-commissioned  officers  and  men.  In  no  previous  war  of  which 
we  have  accurate  statistical  records  has  there  been  so  great  a  loss  of  life  in  a 
similar  period  of  time,  and  the  figures  dealing  with  the  army  can  be  sub- 
mitted to  certain  rough  comparisons. 

Throughout  the  Crimean  campaign  the  British  losses  were  2,755  killed 
and  12,094  wounded  and  our  allies  lost  8,250  killed  and  38,868  wounded. 
In  the  Franco-German  War  of  1870-1871,  during  the  whole  period  from  July 
to  April,  the  Germans  lost  17,750  killed  and  96,189  wounded.  In  the  Russo- 
Turkish  War  of  1877,  the  Russians  lost  32,780  killed  in  action  and  26,286 
wounded.  In  the  absence  of  authoritative  statistics  as  to  the  number  of 
men  engaged,  it  is  impossible  to  compare  the  relative  losses  by  wounds  and 
death  in  the  present  campaign  with  previous  experiences. 

The  ratio  of  wounded  and  missing  is  as  I  to  4.25  or  23.5  per  cent.  In  the 
Crimea,  the  ratio  of  killed  to  the  number  of  wounded  and  missing  was  as 
I  to  4.4  or  22.7  per  cent.;  in  the  Franco-German  War  of  1870,  I  to  5.7  or 
17.53  Per  cent.;  in  the  Russo-Turkish  War,  I  to  2. 17,  or  45. 98  per  cent.;  in 
South  Africa,  I  to  5  or  20  per  cent. 

Dum-Dum. — Dr.  Keen  and  many  English  army  medical 
men  have  pointed  out  that  the  peculiar  nature  of  the  wounds 
inflicted  by  modern  bullets  has  given  rise  to  the  general  notion 
that  various  armies  were  using  dum-dum  bullets.  There  seems 
little  real  evidence  to  substantiate  the  claims  made  earlier  in 
the  war  to  this  effect.  Dr.  Keen  says  of  the  modern  bullet: 

The  shorter  the  range  the  greater  the  explosive  effect,  even  in  soft 
muscles.  At  long  range,  it  may  simply  perforate  the  bone,  especially  near 
joints  where  the  bone  is  spongy  in  texture.  The  trenches  in  Belgium  are 
generally  separated  by  short  or  sometimes  very  short  distances.  The  vio- 
lent explosive  effect  at  short  range  has  given  rise  to  the  charge  by  both  sides 
in  the  present  war  that  dum-dum  bullets  were  being  used. 

[64] 


HYGIENE     AND     WAR 

This  he  thinks  unlikely  and  points  out  further  that  the 
spreading  of  the  jacket  covering  the  bullet  also  tends  to  give 
the  peculiar  wounds.  Many  of  the  wounds  are  found  smooth 
and  clear  cut  where  the  missile  has  entered,  but  shattered  and 
torn  where  it  emerges.  (319,  447,  456,  37,  143) 

Wounds  vs.  Disease. — Seaman  points  out  that  in  the  Russo- 
Japanese  War  the  mortality  was  81,000,  of  whom  60,000  died 
of  battle  casualties ;  30  per  cent,  died  from  diseases,  and  70  per 
cent,  on  the  firing  line.  Thus  modern  war  is  at  least  tending 
to  confine  its  fatalities  more  and  more  to  the  direct  employ- 
ment of  its  engines  of  destruction.  (215,  77,  118) 

Morale  and  Self-Aid. — As  Sager  indicates,  the  fate  of  the 
wounded  depends  upon  the  nature  of  his  wound,  the  place 
where  he  falls,  and  the  time  at  which  he  falls.  The  exigencies 
of  modern  warfare  make  it  impossible  in  most  cases  to  succor 
the  fallen  at  once.  The  great  fatality  rate  among  the  medical 
corps  serves  not  only  to  indicate  this  difficulty  but  to  testify 
to  the  heroism  of  these  men  who  thus  go  into  danger  to  succor 
the  needy.  Promptness  of  first  aid  is  one  of  the  prime  factors 
in  recovery  and  favorable  prognosis.  The  morale  of  the 
wounded  soldiers  has  proved  excellent  and  therefore  has  been 
a  large  factor  in  their  rapid  and  complete  recovery.  The 
difficulties  of  transporting  the  wounded  are  great.  The  hos- 
pital trains,  excellent  as  they  are  at  the  outset,  are  soon 
needed  for  the  transportation  of  active  soldiers  to  the  front 
for  action.  He  suggests  that  in  the  western  region,  the  humus 
and  the  large  amount  of  excreta  from  the  horses  of  the  cavalry 
contribute  to  the  spread  of  tetanus.  He  advocates  drilling 
the  soldier  in  the  administration  of  the  tetanus  serum  by 
himself  upon  himself  and  others  so  that  in  case  of  injury  he 
may  at  once  be  inoculated.  (203) 

Peculiar  Manifestations. — Bottiner  found  among  the  wounded 
coming  under  his  observation  some  peculiarities  not  mentioned 
in  the  texts.  There  were  certain  subjective  phases  present. 
For  example — some  felt  the  impact  of  the  projectile  as  a 
blunt  force;  others  had  a  sensation  of  warmth  in  the  region  of 
the  wound;  two  soldiers  who  were  about  to  'hurrah'  found 


HYGIENE     AND     WAR 

they  could  not  raise  their  right  arms;  some  had  short  breath, 
hemoptysis,  though  always  present,  was  not  always  accom- 
panied by  pain  at  the  onset,  it  came  later.  The  pain 
seemed  to  radiate  in  a  most  bewildering  manner  in  every 
direction  except  to  lower  extremities  (in  most  cases  this  was 
due  to  actual  nerve  injury).  He  found  a  psychic  component 
was  recognizable  in  some  of  these  cases,  and  also  states  that 
abdominal  tension  was  due  to  irritation  of  the  intercostal 
muscles.  It  was  sometimes  severe  on  penetration  of  the  dia- 
phragm. (26) 

Air-Darts. — Modification  of  the  weapons  used  brings  about 
a  corresponding  change  in  the  nature  of  the  wounds.  The  use 
of  aviators'  darts  has  revealed  a  particular  type  of  wound. 
These  darts  do  not  penetrate  the  bone  but  traverse  the  adja- 
cent soft  parts  in  a  peculiar  fashion.  They  may  pierce  a 
blood  vessel,  penetrate  several  important  viscera  at  once,  set 
up  peritonitis.  In  the  treatment,  both  the  entrance  and  the 
exit  of  the  dart  have  to  be  handled  carefully.  The  former  is 
liable  to  be  overlooked.  (455) 

New  Methods. — A  year  of  war  worked  a  revolution  in 
the  army  surgeon's  method  of  dealing  with  the  ordinary 
wounds  of  the  battlefield.  These,  on  account  of  the  changed 
character  of  the  projectiles,  are  more  severe  than  in  previous 
wars.  In  almost  every  instance  of  wounds  from  modern 
artillery,  the  broken  tissues  are  found  by  the  surgeon  to  have 
become  infected  by  scraps  of  cloth  or  other  material,  on  a 
scale  without  precedent.  At  the  start  most  of  the  surgeons 
relied  on  astringent  application  or  recognized  methods  of 
antisepsis  to  combat  this  infection.  The  tissues  were  deluged 
with  a  powerful  germicide,  even  strong  carbolic  acid  being 
employed. 

The  success  of  this  method,  however,  was  far  from  com- 
plete, and  gradually  a  new  system,  based  on  well-known 
principles  but  entirely  novel  in  application,  was  substituted. 

One  of  the  elementary  principles  of  physics  is  that  if  a 
vessel  contains  two  solutions  of  varying  strength,  divided  from 
each  other  by  an  animal  membrane,  matter  will  pass  from  the 

[66] 


HYGIENE     AND     WAR 

weaker  to  the  stronger  solution  until  ultimately  both  are  the 
same  strength.  This  principle  was  brought  into  action  in  the 
treatment  of  wounds  in  order  to  stimulate  the  action  of  the 
serum  of  the  blood,  which  has  a  strong  antiseptic  property. 
The  wound  is  rilled  with  a  water  solution  of  salt  and  sodium 
citrate  at  a  considerably  greater  concentration  than  that  in 
the  serum  of  the  blood.  Under  the  influence  of  this  liquid 
the  serum  is  poured  out  from  the  body  into  the  wound,  tend- 
ing both  to  cleanse  it  and  to  kill  the  bacteria  that  are  present. 

This  system  has  the  great  advantage  that  it  leaves  the  tissues  unimpaired 
by  the  fluids  used  for  the  destruction  of  the  germs.  "The  full  recognition 
of  the  efficiency  of  this  method,  introduced  largely  through  the  efforts  of  Sir 
Almroth  Wright,"  says  a  medical  writer,  "must  be  regarded  as  one  of  the 
most  important  advances  made  in  surgery  as  a  result  of  the  war."  (Asso- 
ciated Press  Dispatch,  London.) 

Makins  also  reports  that  most  wounds  are  from  shrapnel 
and  that  machine-gun  wounds  come  next.  The  wounds  from 
the  former  resemble  very  much  the  old  musket  wounds.  They 
are  easily  infected.  The  wounds  from  the  machine  guns  are 
usually  aseptic.  Most  of  the  wounds  do  well.  Their  degree 
of  severity  varies  with  the  velocity  of  the  shrapnel  balls  at 
the  time  of  impact.  (143) 

Sir  Almroth  Wright  in  an  address  stated  that  most  wounds 
in  the  present  war,  referring  for  the  most  part  to  troops  in 
the  western  campaign,  are  found  to  be  heavily  infected. 
Streptococci  and  fecal  infection,  especially  the  latter,  being 
outstanding  features.  The  gas-plegmon  bacillus  and  tetanus 
bacillus  are  frequent.  Of  the  three  methods  of  treatment  of 
wounds,  namely,  by  antiseptics,  by  vaccine  therapy,  by  physio- 
logical methods,  he  considers  the  vaccine  best.  (266) 

In  the  case  of  abdominal  wounds,  great  care  should  be  exer- 
cised in  deciding  whether  the  patient  should  be  moved.  In 
general,  these  cases  are  not  transportable.  This  should  be 
impressed  upon  the  carriers  (bearers).  The  patient  should  be 
given  neither  food  nor  drink  except  as  directed  by  the  medical 
officer. 

In  case  of  injury  do  not  touch  the  wound  with  the  hands. 


HYGIENE   AND   WAR 

ROLE  OF  DISEASES  IN  WAR 

General. — Major  Lelean  (133)  states  that  yellow  fever  carried 
off  50,000  out  of  58,000  men  in  the  San  Domingo  campaign 
of  1802;  that  in  1812  the  Bavarian  force  mustered  only  3,000 
out  of  28,000,  owing  to  loss  from  typhus  fever;  that  the 
Russians  lost  one-half  of  120,000  men  after  Plevna  from  the 
same  cause;  that  the  allies  lost  10,000  from  cholera  in  the 
Crimean  War;  that  in  the  last  Balkan  War  the  Turks  lost 
daily  from  cholera,  500;  that  in  1828  the  plague  took  6,000 
in  one  month  from  the  Russian  army;  that  dysentery  caused 
1,342  deaths  and  38,000  cases  of  sickness  in  the  South  African 
War,  and  in  the  same  war  England  had  57,000  cases  of  enteric 
with  8,000  deaths;  in  the  war  of  1870-1871  Germany  had  73,000 
enteric  cases  with  8,900  deaths;  in  the  Spanish-American  War 
66  per  cent,  of  the  typhoid  cases  could  be  traced  to  contact 
infection. 

Keefer  (116)  claims  that  Montgomery  and  Arnold  failed 
in  their  invasion  of  Canada  in  1775  because  of  their  great  loss 
from  small-pox  and  dysentery;  Napoleon  failed  to  found  a 
colony  in  the  southern  part  of  the  United  States  because 
15,000  of  his  finest  men  perished  from  yellow  fever  and  other 
tropical  diseases  in  San  Domingo  in  1802;  the  British  lost 
25  per  cent,  more  from  disease  than  any  other  cause  in  the 
Crimean  War.  In  the  Spanish-American  War  the  losses  from 
disease  were  seven  times  those  from  injury.  It  may  be  that 
the  occurrence  of  30,000  cases  of  cholera  and  dysentery  in 
the  Bulgarian  army  may  account  for  their  failure  to  take 
Constantinople.  The  failure  of  the  French  in  their  efforts 
to  build  the  Panama  Canal  was  due  largely  to  their  inability 
to  control  health  conditions.  Our  success  is  due  to  our  excel- 
lent military  corps  of  hygiene  and  sanitation.  The  following 
table  will  indicate  the  r61e  played  by  disease  in  war: 


[68] 


HYGIENE     AND     WAR 
TABLE  I 


(No.  212,  Weyl's  Handbook) 


NAME 

OF 

WAR 

NAME 

OF 

ARMY 

DEATHS 

On  the 
Battlefield 

Later  from 
Wounds 

From 
Sickness 

Total 

abs 

0/00 

K* 

abs 

0/00 

K 

abs 

0/00 

K 

abs 

0/00 

X 

Crimean, 
1  8  54.-  56 

English.  .  . 
French.  .  . 

French  .  .  . 
Prussia  .  .  . 
Danes  

Prussia  .  .  . 

Germans  . 
Russian: 
Danube.  . 
Caucasus  . 

Japanese  . 
U.  S. 

2755 
8250 

2536 
442 
610 

2553 
17255 

11905 

? 

724 
643 

28.2 
26.7 

2O.O 

6.6 
ii-3 

9.1 

21.2 

2O.  I 

? 

I2.O 

3-0 

1847 
9923 

2962 
316 
836 

1455 
11023 

4955 
1869 

231 

325 

18.9 
32.1 

22.9 
4-9 

15-5 

5-2 
13-5 

8.4 
7-6 

3-8 
1-5 

17579 
59273 

13788 
3io 
820 

5219 
14904 

45969 
35572 

3H8 
5438 

179.6 
191.7 

105.8 
4-9 
I5-I 

18.6 
18.2 

77-6 
M4.3 

51-6 
25-7 

22181 
77446 

19286 
1048 
2266 

9227 
43182 

62829 
37441 

4H3 
6406 

226.7 
250.4 

148.7 
16.5 
41.9 

32.9 
52.9 

106.1 
I5L9 

67.5 
30.3 

War  in  Italy, 
1850   . 

War  vs.  Den- 
mark, 1864.  . 
War  in  Bohe- 
mia, 1866  
Franco-  Prus- 
sian, 1870-71. 
Russo-Turk, 
j877_78.  . 

Jap-China, 
1804-05.  . 

Spanish-Amer- 
ican, 1898-99. 

*  K  is  approximate  number  per  thousand. 

Losses  United  States  Civil  War. — That  we  may  have  a  more 
adequate  idea  of  the  real  losses  due  to  war,  let  us  consider 
our  Civil  War.  We  shall  present  such  facts  as  seem  incontro- 
vertible and  indicate  where  figures  presented  are  the  best 
possible  estimates.  For  Jordan  has  again  rightly  stated,  "To 
weigh  statistics  is  impossible,  for  the  statistics  we  need  have 
never  been  collected;"  and  we  must  add,  conditions  existing 
in  former  wars  having  changed,  are  impossible  of  obtaining 
at  this  date.  This  author  states  concerning  the  losses  of 
the  North  and  South: 

These  losses  are  usually  estimated  at  about  700,000  men  divided  in  the 
proportion  of  400,000  to  300,000.  .  .  .  This  loss  represents  about  two 
percent,  of  the  white  population  of  the  North  and  about  ten  per  cent,  of  that 

[69] 


HYGIENE     AND     WAR 

of  the  South.   .      .      .  This  loss  fell  on  that  part  of  the  community  racially 
most  valuable,  the  young  men  between  the  ages  of  eighteen  and  thirty-five. 

A  study  of  statistics  relative  to  the  losses  of  the  North  and 
South  will  serve  to  emphasize  the  conclusion  given  previously. 

When  the  war  closed,  there  were  in  the  field,  on  the  3Oth  day  of  April, 
1865,  1,000,516  men  actually  in  service  and  an  enrolment  of  2,245,063  men 
subject  to  draft.  This  would  make  the  total  fighting  force  of  the  free  states 
between  the  ages  of  eighteen  and  forty-five  and  in  good  physical  health 
and  not  including  foreigners  not  naturalized,  to  be  3,245,579  men. 

CASUALTIES 

Deaths  from  wounds 96,089 

Deaths  from  diseases 184,331 

Desertions 199,045 

Honorably  discharged i?4»577 

Discharged  for  disability 224,306 

Dishonorably  discharged 5,39° 

Resignations 22,281 

Missing,  etc 7,063 


Total 914,082 

Above  refers  to  Union  army  only.     (250,  p.  267) 

Summary  of  the  number  of  men  called  for  by  the  President  of  the  United 

States;  and  furnished  by,  and  credited  to,  the  states  and  territories  during 

the  War  of  the  Rebellion  (182).    (See  table,  page  71.) 


[70] 


HYGIENE     AND     WAR 


M 

en 

Aggre- 

States and 
Territories 

Quota 

Fur- 
nished 

Paid 
commu- 
tation 

Total 

gate 
Reduced 
to  a  three 
years' 
standard 

Maine                     

7^.S87 

70,107 

2,007 

72.1  14 

s6  776 

New  Hampshire 

-JK  87Q 

'I'l  077 

692 

T.A  620 

T.Q  T.AQ 

Vermont           

12,074 

33,288 

1,974 

^.262 

29,068 

Massachusetts 

I-IQ  o^S 

14.6  7^O 

5  -218 

I  S2  O4.8 

124  IO4 

Rhode  Island  

18,898 

21,2l6 

46^ 

2^,600 

17,866 

Connecticut  
New  York  
New  Jersey  
Pennsylvania          .    ... 

44,797 
507,148 
92,820 
185  ^60 

55,864 
448,850 
76,814 

H7  Ql6 

1,515 
18,197 
4,196 
28  171 

57,379 
467,047 
81,010 
^66  107 

50,623 
392,270 
57,908 
26^  SI7 

Delaware     

13,935 

12,284 

1,386 

13,670 

IO,322 

Maryland           

7O,o6s 

46  618 

3,678 

SO  ^16 

4.1,  275 

West  Virginia  

14,461 

32,068 

32,068 

27,714 

District  of  Columbia  .... 
Ohio                        

13,973 

-206  ^22 

16,534 
1.1  1.  1  80 

338 
6  4.7Q 

16,872 

•IIQ  6^0 

11,506 
24O  SI4 

Indiana 

IQO  788 

1  06  161 

784 

107  147 

jc'j  ^76 

Illinois                

244  4Q6 

250  OQ2 

ce: 

2  SO  147 

214.1^'; 

Michigan 

05  OO7 

87  l64 

8  ooo 

8q  172 

80  III 

Wisconsin           

109,080 

QI.127 

c  OQ7 

06  424 

7Q,26o 

Minnesota             

26  126 

24  O2O 

I  0^2 

2S  o^2 

IQ  60^ 

Iowa 

7Q  521 

76  242 

67 

76  ^OQ 

68  6^0 

Missouri       

I22,4Q6 

IO9  III 

IO9  III 

86,5^0 

Kentucky  

Kansas 

100,782 

1-7  OH 

75,760 
2O  I4Q 

3,265 

2 

79,025 

2O     I  SI 

70,832 
1  8  706 

Tennessee  
Arkansas  
North  Carolina  

1,560 

780 

1,560 

31,092 
8,289 
3,156 

31,092 
8,289 

•2  i=;6 

26,394 
7,836 
3,156 

California  
Nevada     

15,725 
1,  080 

15,725 

1,  080 

15,725 
1,  080 

Oregon          .        

1,810 

I  810 

1,771 

Washington  Territory 

064 

064 

064. 

Nebraska  Territory  

3.IS7 

7,  I=;7 

2,175 

Colorado  Territory  

4  OO1 

4  OO^ 

i  6Q7 

Dakota 

206 

206 

206 

New  Mexico  

6,561 

6,s6l 

4,432 

Alabama  

2,576 



2,576 

1,611 

HYGIENE     AND     WAR 


M 

en 

Aggre- 

States and 
Territories 

Quota 

Fur- 
nished 

Paid 
commu- 
tation 

Total 

gate 
Reduced 
to  a  three 
years' 
standard 

Florida  

I  2QO 

I  2QO 

i  290 

Louisiana 

c  224. 

c  224. 

4.  6^4. 

Mississippi 

C4.c 

CA  e 

CA  e 

Texas  

I,o6s 

I,o6s 

I  6^2 

Indian  Nation  

T.,^0 

^    C-2Q 

-i  c^o 

Colored  Troops 

0-2,44.1 

Q7   4.AI 

oi  780 

Total  

2,76^,670 

2,772,408 

86,744 

2,8SQ,l^2 

2,^20,272 

(182,  pp.  10-11.) 

The  numbers  given  opposite  'colored  troops'  in  the  foregoing  table  show, 
not  the  total  number  of  colored  troops  enlisted,  but  simply  the  number  of 
those  who  were  organized  at  various  stations  in  the  states  in  rebellion,  and 
who  could  not  be  at  the  time,  and  were  not,  assigned  or  specifically  credited 
to  states. 

The  total  number  of  colored  troops  enlisted  during  the  war  was  186,097. 

In  the  regular  army  there  were  enlisted  during  the  war  about  67,000  men; 
of  these,  probably  not  more  than  two-thirds  were  credited  to  the  states. 

For  the  men  furnished  for  service  for  a  shorter  period  than  ninety  days, 
with  a  few  exceptions,  states  received  no  credit.  Many  men  were  furnished 
for  service  of  thirty  days,  notably  in  the  summer  of  1863.  How  many  men 
were  thus  furnished  it  is  not  practicable  to  state,  but  an  estimate  may  be 
based  on  the  number  (17,213  officers  and  men)  furnished  by  the  state  of 
New  York.  . 

Nevertheless,  it  is  safe  to  say  that  the  total  number  of  men  furnished  by 
the  states  and  territories  for  the  armies  of  the  United  States,  after  deducting 
those  credited  for  service  in  the  navy,  will  exceed  2,850,000  men. 

In  this  number,  men  who  re-enlisted  are  counted  twice  or  even  oftener. 
To  give  the  number  of  individual  persons  who  served  in  the  army  during 
the  war  is  not  practicable,  nor  is  it  of  any  practical  benefit. 

Indicative  of  the  type  of  men  constituting  the  volunteers, 
we  may  offer  the  evidence  of  a  Secretary  of  War.  (182,  p.  23) 

The  Secretary  of  War,  in  his  report  dated  November  22,  1865,  makes  the 
following  remarks,  which  show  more  than  anything  else  the  spirit  animating 
the  people  of  the  loyal  states:  "On  several  occasions,  when  troops  were 

[72] 


HYGIENE     AND     WAR 


promptly  needed  to  avert  impending  disaster,  vigorous  exertion  brought 
them  into  the  field  from  remote  states,  with  incredible  speed.  Official 
reports  show  that  after  the  disasters  on  the  Peninsula,  in  1862,  over  80,000 
troops  were  enlisted,  organized,  armed,  equipped  and  sent  into  the  field  in 
less  than  a  month.  Sixty  thousand  troops  have  repeatedly  gone  into  the 
field  within  four  weeks.  Ninety  thousand  infantry  were  sent  to  the  armies 
from  the  five  states  of  Ohio,  Indiana,  Illinois,  Iowa  and  Wisconsin  within 
twenty  days.  When  Lee's  army  surrendered,  thousands  of  recruits  were 
pouring  in,  and  men  were  discharged  from  recruiting  stations  and  rendez- 
vous in  every  state." 

We  have  quoted  the  data  given  by  one  author  as  to  the 
losses.  We  find  a  difference  in  figures  due  to  different  times 
and  methods  of  getting  them.  From  cumulative  evidence 
from  the  Adjutant-General's  office  and  that  of  the  Surgeon- 
General  a  more  accurate  estimate  of  the  total  deaths  of  the 
Union  army  in  round  numbers  is  313,000.  (182,  p.  71) 

In  his  work,  'Strategos',  Lieutenant  Totten,  of  the  United  States  army, 
computes  the  annual  loss  per  one  thousand  men  of  mean  aggregate  strength, 
actually  enrolled  or  engaged,  to  have  been  as  follows: 


Regu- 
lars 

Volun- 
teers 

White 

Col- 
ored 

Mixed 

General  mortality           

4-7.6 

7C  4. 

74.6 

176  ^ 

7Q.7 

Killed  in  battle 

IQ  Q 

18  8 

18  Q 

10  6 

18  d. 

Died  of  wounds        

II.  7 

1  1.  2 

II.  2 

10.8 

10.8 

Total  loss  by  death,  per 
l,ooo  men  per  annum.  .  . 

79.2 

1054 

104.7 

197.7 

108.9 

Killed  in  action,  I 

Died  of  wounds,  I 

Died  of  disease,  etc.,  I 

Captured,  etc.,  I 

Wounded  in  action,  I 

Died  while  a  prisoner,  I 
Died  while  in  service,  I 


man  out   of  every  42.7   effective  and   actively 
engaged  men 

man  out  of  every  38.1   effective  and  actively 
engaged  men 

man  out  of  every  13.5  men  of  total  the  force 
furnished 

man  out  of  every  10.2  of  total  force  furnished 
(men  effective  and  actively  engaged) 
man  out  of  every  6.7  of  total  force  furnished 
(men  effective  and  actively  engaged) 
man  out  of  about  every  7.0  captured 
man  out  of  every  9.3  men  of  the  total  force  fur- 
nished   (182,  p.  72) 


73 


HYGIENE     AND     WAR 


DEATHS  IN  HOSPITALS   (182,  pp.  72-73) 

In  the  hospitals  of  the  army  6,049,648  cases  were  treated  by  the  officers 
of  the  medical  department,  and  the  deaths  have  been  classified  by  the  sur- 
geon-general as  follows: 


WHITE 
TROOPS 

COLORED 
TROOPS 

TOTAL 
DEATHS 

Cases 
Treated 

Deaths 

Cases 
Treated 

Deaths 

CLASS  I.  —  Zymotic  Diseases 

Order    No.    I,    Miasmatic    Dis- 

eases;   this  order  is  again  di- 

vided into  23  divisions     

3,  285,^76 

02,1  ^O 

^60  6SQ 

i6.s^7 

108,687 

Order  No.  2,  Enthetic  Diseases; 

o>   wo>o  / 

7      9      Ow 

O     y  i^d:? 

,00  / 

divided  into  7  sub-divisions    . 

192,504 

162 

14,948 

37 

199 

Order  No.  3,  Dietetic  Diseases; 

sub-divided  into  6  divisions.  . 

42,944 

1,124 

16,460 

416 

1,540 

CLASS  11.—  Constitutional  Dis- 

eases 

Order  No.  i,  Diathetic  Diseases; 

sub-divided  into  8  divisions    . 

288,287 

1,226 

35,922 

58i 

1,807 

Order   No.   2,   Tubercular   Dis- 

eases; divided  into  3  sub-divi- 

sions    

19,890 

5.418 

^,85Q 

1.296 

6.714. 

CLASS  III.  —  Parasitic  Diseases 

O>T"      w 

O  J     \jy 

Wj  f     A  ~|- 

Divided  into  5  divisions  

35,660 

8 

i  810 

6 

14. 

CLASS  IV.  —  Local  Diseases 

OO>          7 

o, 

T" 

Order  No.  I  ,  Diseases  of  nervous 

system;    divided  into  13  sub- 

divisions 

1  70  0^2 

A  4.4.2 

2T.  Q26 

8is 

52^7 

Order  No.  2,   Diseases  of  eye; 

J.  /  V-'>V/O 

f|f«|4|*6 

•^0,7-^^ 

"AO 

J^O/ 

sub-divided  into  7  divisions.  . 

88,701 

2 

7,599 

I 

3 

Order  No.  3,  Diseases  of  ear;  5 

divisions  

28,918 

6 

2,080 

I 

7 

Order  No.  4,  Diseases  of  organs 

of  circulation;  n  divisions.  .  . 

25,106 

1,658 

i,559 

467 

2,125 

Order  No.  5,  Diseases  of  respira- 

tory organs;  1  1  divisions  

448,923 

17,902 

55,i89 

6,19 

24,100 

[74] 


HYGIENE     AND     WAR 


WHITE 

COLORED 

TROOPS 

TROOPS 

TOTAL 

Cases 
Treated 

Deaths 

Cases 
Treated 

Deaths 

DEATHS 

Order  No.  6,  Diseases  of  Diges- 

tive organs;  23  divisions  

563,239 

4,146 

54,271 

971 

5,H7 

Order  No.  7,  Diseases  of  urinary 

and  genital  organs;    13  divi- 

sions          

2Q  8?  S 

4.^0 

^  016 

J7I 

=i6i 

Order  No.  8,  Diseases  of  bones 

.7)    /  0 

TO'"' 

O  J 

o 

y* 

and  joints;  9  divisions  

8,079 

47 

950 

15 

62 

Order  No.  9,  Diseases  of  integu- 

mentary system  ;  7  divisions  .  . 

189,817 

216 

11,760 

27 

243 

CLASS  V.—  Wounds,  Accidents, 

and  Injuries 

Order  No.  I,  Wounds,  accidents 

and  injuries;  16  divisions.  .  .  . 

400,933 

36,688 

24,337 

1,427 

38,H5 

Order  No.  2,  Homicide  

144 

30 

174 

Order  No.  3,  Suicide  

301 

9 

310 

Order  No.  4,  Execution  of  sen- 

tence                            

104. 

•ZQ 

14.  T. 

Unclassified  diseases 

7  l8? 

J.  Vf 

4.4.Q 

O;/ 

TO 

4.4.Q 

/  >            / 

T-'fV 

T-T-y 

Total 

5  825  4.80 

116,623 

62Qt^  S4- 

2Q.OO4 

IQS.627 

Of  these  cases  and  deaths,  there 

O,O,  T 

VfOUT" 

**  J7,          T" 

J.   ^X})V-''*'    / 

occurred  in  the  year  ending 

June  30   1866 

24.^  Q54. 

47-15 

I  ^Q  2^2 

C    C-2Q 

IO.274. 

Leaving  cases  and  deaths,  from 

•^TO^OT- 

,  /  oo 

•••  O:7»     O 

O,OO  :x 

A  V/y^r  f   i-J- 

May  i,  1861,  until  June  30, 

1865 

5,579,526 

116,888 

470,122 

23,465 

185,353 

75 


HYGIENE     AND     WAR 


The  largest  number  of  deaths  occurred  from  the  following  diseases: 
(182,  p.  74) 


WHITE 
TROOPS 

COLORED 
TROOPS 

TOTAL 

Of  Class  I 
Typhoid  fever,  Order  No.  I  

27,0^6 

2  2^O 

2Q  -i^g 

Typho-malarial  fever,  Order  No.  I  .  .  .  . 
Remittent  fever,  Order  No.  I  
Congestive  intermittent  fever,   Order 
No.  i           

4,059 
3,853 

•3.  -170 

1,301 
1,002 

7QA 

5,360 
4,855 

4164. 

Acute  diarrhoea,  Order  No.  I  

2  Q2^ 

I  ^68 

,i\j^j. 

42QT 

Chronic  diarrhoea  Order  No.  I   

27  558 

327Q 

,^yi 
or*  816 

Acute  dysentery  Order  No.  I 

A   O84. 

I  4Q2 

5^76 

Chronic  dysentery,  Order  No.  I    
Erysipelas  Order  No.  I   .       

3,229 

I  860 

625 

247 

O/u 

3,855 

2  108 

Small-pox  and  varioloid 

A  717 

2  ^41 

7  O^8 

Measles,  Order  No.  I  

4,24.6 

Q^I 

/  ,UD° 

5177 

Of  Class  II 
Consumption,  Order  No.  2  

S.286 

I  211 

6  4O7 

Of  Class  IV 
Inflammation  of  Brain,  Order  No.  I..  . 
Inflammation  of  Lungs,  Order  No.  5  .  . 

Of  Class  V 
Gun-shot  wounds,  Order  No.  I   . 

1,269 
14,738 

^2  007 

262 
5,233 

I  O42 

1,531 
19,971 

•     \ 

-3-3   QAQ 

oo,yi4-V 

Total                

141  155 

27  408 

164  ^67. 

The  foregoing  tables  do  not  embrace  those  who  died  of  wounds  or  diseases 
while  prisoners  of  war,  or  those  who  died  while  on  furlough,  leave  of 
absence  or  absence  without  leave. 

DISCHARGES  FOR  DISABILITY 

The  Adjutant-General,  in  his  report  dated  October  25,  1870,  gives  the 
number  discharged  for  disability  during  the  war  as  285,245  men,  as  follows: 

Enlisted  men  of  the  regular  army 6,541 

Enlisted  men  of  the  volunteer  army 269,197 

Enlisted  men  of  the  colored  troops 9,807 

We  can  not  obtain  data  with  reference  to  the  Confederate 
forces  and  their  losses,  which  are  complete  or  entirely  satis- 

[76] 


HYGIENE     AND     WAR 


factory.  Their  country  was  devastated,  occupied  by  the 
enemy.  There  were  no  local  means  of  keeping  records  and 
the  whole  resources  of  the  South  were  being  used  in  the  pro- 
cedure of  war.  We  are  therefore  compelled  to  present  what 
seem  reasonable  estimates  from  which  conservative  inferences 
may  be  drawn. 

In  February,  1865,  the  superintendent  of  the  Bureau  of  Conscriptions 
reported  to  the  Secretary  of  War  in  detail  by  classes  the  number  of  persons 
exempt  from  conscription  by  physical  disability  or  by  law,  or  detailed  in 
each  state  east  of  the  Mississippi,  the  total  of  which  (including  4,612 
detailed  in  government  bureaus  and  departments)  was  87,863.  The  minute- 
ness of  this  report  makes  it  impossible  to  believe  that  any  considerable 
number  who  were  not  exempt  from  military  service  escaped  the  search  of 
the  Bureau  of  Conscription,  and — taken  in  connection  with  urgency 
shown  in  the  legislation  and  correspondence  above  set  out — it  warrants  the 
assertion  that,  in  that  part  of  the  Confederacy  east  of  the  Mississippi,  sub- 
stantially every  male  white  from  seventeen  to  fifty  was  swept  into  the  ranks  of 
the  Confederate  Army,  except  the  87,863  exempts,  and  those  who  were  in 
hiding  or  had  joined  the  Union  Army.  (136,  p.  18) 

RATIO    OF    ESTIMATES    OF    CONFEDERATE    NUMBERS    TO 
NUMBER  OF  UNION  ENLISTMENTS 

(136,  p.  40) 


Estimate  of  Confederate 
Numbers 

Men  in 
Confederate 
Army 

Enlistment 
in  Union 
Army 

Per  cent. 

Marcus  J   Wright 

600,000 
to 

2,808,304 

20:24 

Early,  Stephens  and  Jones  

700,000 
600,000 

20 

Partial  Estimate 

885  ooo 

30 

Estimate  from  the  Census,  about 
Estimate  from  the  number  aver- 
age strength  of  regiments  

Estimate  of  War  Records  Office 
Cassellman  

1,234,000 

1,227,890 

or 
1,406,480 

1,000,000 

i  500  ooo 

41 

41 
or 

47 
34 

CQ 

77 


HYGIENE     AND     WAR 

This  author  gives  as  an  estimate  from  Confederate  sources, 
94,000  as  killed  or  mortally  wounded,  which  upon  the  usual 
basis  would  bring  the  total  of  killed  and  wounded  to  about 
329,000.  His  calculations  show  more  Confederate  soldiers  hit 
in  engagement  with  Northern  troops.  Preponderance  of  num- 
bers on  the  part  of  the  latter  partially  explains  this.  When 
one  considers  that  even  the  young  boys  of  the  South,  practi- 
cally all  the  males  (white),  were  in  arms,  that  their  organiza- 
tion was  such  as  to  leave  little  means  for  adequate  medical 
treatment  and  care,  it  is  but  reasonable  to  infer  that  their 
losses  from  wounds  and  diseases  would  be  proportionately 
greater  than  those  of  the  North.  Adequate  facts  concerning 
home  conditions  in  a  medical  way  are  lacking  in  both  North 
and  South.  But  it  must  follow  that  the  people  left  at  home 
in  the  South,  deprived  of  the  service  of  their  medical  men, 
forced  into  a  life  to  which  they  were  unaccustomed,  foraged 
upon  by  the  invaders,  forced  to  give  out  of  their  poverty, 
suffered  not  only  from  privation  and  from  local  diseases  but 
from  those  incident  to  a  marching  troop  bent  on  a  policy 
of  devastation  and  to  some  extent  pillage. 

As  a  source  of  data  bearing  upon  all  social  phases  of  war 
and  especially  losses  due  to  it  from  diseases,  etc.,  we  present 
herewith  an  outline  of  Dr.  Schwiening's  article : 

212     von  Schwiening,  Dr.  H.    Krieg  und  Friede  (War  and  Peace). 

Handbuch  der  Hygiene  von  Dr.  Theodor  Weyl  IV.  Sup- 
plement band,  Soziale  Hygiene,  1904,  pp.  655-726. 
Jena.  Gustav  Fischer, 

WAR  AND    PEACE 

I.     Influence  of  war  and  peace  in  destructive  respects: 

1.  Directly 

a.  Through  loss  of  disabled  and  dead 

b.  Through  loss  of  invalids 

2.  Directly  through  its  influence  upon 

a.  Marital  relations 

b.  Births 

c.  Deaths 

d.  Emigration  (inferential) 

[78] 


HYGIENE     AND     WAR 

II.     Influence  of  war  and  peace  in  epidemic  respects: 

1.  In  general 

2.  In  particular 

a.  Leprosy 

b.  Syphilis 

c.  Plague 

d 

e.  English  Sweating  Sickness 

f.  Hungarian  Sickness 

g.  War  Typhus 
h.  Cholera 

i.  Small  pox 

3.  Prophylaxis  against  the  spread  of  contagion  through  war 

4.  Battlefield  hygiene 

III.  Influence  of  war  in  social  and  moral  statistical  respects: 

1.  Alcohol 

2.  Prostitution 

3.  Immorality  (assaults  against  decency) 

4.  Mental  diseases 

5.  Suicide 

IV.  Influence  of  war  and  peace  in  hygienic  respects: 

1.  Conduct  of  hospitals 

2.  Attendants 

3.  Hygienic  means  of  nourishment. 

CLOSING  REMARKS: 
Literature  (excellent  bibliography  of  148  titles) 


[79l 


III.     ECONOMIC  RESULTS  OF  WAR 

BURDEN  UPON  THE  WHOLE  PEOPLE — ECONOMIC,  SOCIAL, 
AND  MORAL 

Indicative  of  the  general  results  along  economic  lines  of  all 
wars  are  the  data  given  by  the  Balkan  Commission.  Their 
exposition  deserves  careful  consideration. 

Cost  of  the  Balkan  War. — From  the  economic  point  of  view  war  is  a 
destruction  of  wealth. 

Even  before  war  is  declared,  the  prospect  of  conflict  between  the  coun- 
tries in  which  serious  difficulties  have  arisen,  affects  the  financial  situation. 
Anxiety  is  aroused  and  failures  are  caused  on  the  market  by  the  fluctuations 
of  government  and  other  securities  of  the  states  concerned.  Credit  facilities 
are  restricted;  monetary  circulation  disturbed;  production  slackened,  orders 
falling  off  to  a  marked  degree;  and  an  uncertainty  prevails  which  reacts 
harmfully  on  trade. 

Then  comes  the  declaration  of  war  and  mobilization.  The  able-bodied 
men  are  called  to  the  standards;  between  one  day  and  the  next  work  stops 
in  the  factories  and  fields.  With  the  cessation  of  the  breadwinner's  wages, 
the  basis  of  the  family  budget,  the  wife  and  children  are  quickly  reduced 
to  starvation,  and  forced  to  seek  the  succor  of  their  parishes  or  the  state. 

The  whole  of  the  nation's  activities  are  turned  to  war.  Goods  and  pas- 
senger traffic  on  the  railroads  come  to  an  end;  rolling  stock  and  rails  are 
requisitioned  for  the  rapid  concentration  of  men,  artillery,  ammunition, 
and  provisions  at  strategic  points. 

Not  only  does  the  country  cease  to  produce,  but  it  consumes  with  great 
expense  in  the  hurry  of  operations.  Its  reserves  are  soon  exhausted;  the 
taxes  are  not  paid.  If  it  can  not  appeal  for  loans  or  purchases  abroad,  it 
suffers  profoundly. 

Then  the  fighting  begins,  and  with  it  the  hecatombs  of  the  battlefields, 
the  earth  heaped  with  dead,  the  hospitals  overflowing  with  wounded. 
Thousands  of  human  lives  are  sacrificed ;  the  young,  the  strongest,  who  were 
yesterday  the  strength  of  their  country,  who  were  its  future  of  fruitful  labor, 
are  laid  low  by  shot  and  shell.  Those  who  do  not  die  in  the  dust  or  mud, 
will  survive,  after  countless  suffering,  mutilated,  invalided,  no  longer  to  be 
counted  on  for  the  prosperity  of  the  land.  And  it  is  not  only  the  population, 
that  essential  wealth,  that  is  thus  annihilated.  In  a  few  hours  armies  use 
up  for  mutual  destruction,  great  quantities  of  ammunition,  while  highly 
expensive  supplies  of  cannon,  gun  carriages,  and  arms  are  ruined.  There  is 

[8ol 


HYGIENE     AND     WAR 

a  destructive  bombardment  of  towns,  villages  in  flames,  the  harvest 
stamped  down  or  burned,  bridges,  the  most  costly  items  of  a  railway, 
blown  up. 

The  regions  traversed  by  the  armies  are  ravaged.  The  non-combatants 
have  to  suffer  the  fortunes  of  war;  invasion,  excesses,  and  it  may  be  flight, 
with  the  loss  of  their  goods.  Thousands  of  wretched  families  seek  security 
at  the  price  of  cruel  fatigue  and  the  loss  of  everything — their  land  and 
their  traditions — acquired  by  the  efforts  of  many  generations. 

The  Commission  arrived  in  the  Balkans  after  the  fighting  was  over, 
and  was  able  to  study  the  results  of  war  at  the  very  moment  when,  the 
period  of  conflict  closed,  each  nation  was  beginning  to  make  its  inventory. 

.  .  .  Nevertheless,  the  traces  of  the  war  were  still  fresh.  The  Com- 
mission noted  them.  If  the  corpses  of  the  victims  were  not  visible  their 
countless  graves  were  everywhere,  the  mounds  not  yet  invaded  by  the  grass 
that  will  next  summer  hide  them  away.  Visible,  too,  were  the  wounded  in 
the  hospitals  and  the  mutilated  men  in  the  streets  and  on  the  roads;  the 
black  flags,  hanging  outside  the  doors  of  the  hovels,  a  dismal  sign  of  the 
mourning  caused  by  the  war  and  its  sad  accompaniment,  cholera. 

The  Commission  has  endeavored  to  make  an  estimate  of  the  cost  of 
the  double  war.  Instruction  on  this  head  is  needful.  Public  opinion  needs 
to  be  directed  and  held  to  this  point.  It  is  too  easily  carried  away  by  admi- 
ration for  feats  of  arms,  exalted  by  historians  and  poets;  it  needs  to  be  made 
to  know  all  the  butchery  and  destruction  that  go  to  make  a  victory;  to 
learn  the  absurdity  of  the  notion,  especially  at  the  present  time,  that  war 
can  enrich  a  country;  to  understand  how,  even  from  far  off,  war  reacts  on 
all  nations  to  their  discomfort  and  even  to  their  serious  injury.  (194,  pp. 
235-236.  See  also  Angell's  book,  The  Great  Illusion.) 

The  balance  sheet  of  the  war  must  bear  at  its  beginning,  in  order  to 
characterize  it  properly,  the  list  of  the  dead  and  wounded.  .  .  . 

Below  is  the  sinister  inventory.  (It  should  be  observed  that  this  does 
not  account  for  the  diseases,  privations,  etc.,  of  those  at  home.) 

Bulgaria  had  579  officers  and  44,313  soldiers  killed.  71  officers,  7,753 
soldiers  are  reported  missing — how  many  of  these  are  dead?  1,731  officers, 
102,853  soldiers  were  more  or  less  seriously  wounded.  A  great  number  of 
these  will  remain  invalids,  reduced  greatly  in  strength  or  deprived  of  a 
limb.  .  .  . 

Servia  published  first  of  all  the  following  losses:  about  22,000  dead  and 
25,000  wounded.  .  .  On  Feb.  27,  1914,  the  official  figures  were  given 
to  the  Skupshtina  by  the  Minister  of  War.  There  are  12,000  to  13,000 
killed;  17,800  to  18,800  dead  as  the  results  of  wounds,  cholera,  or 
sickness;  48,000  wounded. 

.  It  was  impossible  for  us  to  find  out  the  figures  of  the  Greek, 
Montenegrin  or  Turkish  losses.  .  .  .  The  Montenegrins  are  said  to 
have  had  a  great  many  killed  in  proportion  to  their  number  on  account 

[81] 


HYGIENE     AND     WAR 

of  their  attitude  under  fire.  .  .  .  From  Turkey  we  have  no  official  in- 
formation. 

This  is  not  all.  Arms  were  not  only  taken  up  against  belligerents,  but 
massacres  took  place  in  Macedonia  and  Albania.  Old  people,  villagers, 
farmers,  women  and  children,  fell  victims  to  the  war.  .  .  . 

It  is  not  possible  to  compute,  chapter  by  chapter,  the  extent  of  the  mate- 
rial losses  by  destruction  of  property.  (194,  pp.  243-244) 

For  this  reason  the  best  we  can  do  is  to  present  a  table 
of  the  costs,  estimated  by  the  various  contending  nations. 
Of  these  reports  the  Commission  says: 

They  are  evidently  open  to  the  suspicion  of  being  exaggerated.  .  .  . 
Thus  in  a  document  sent  us  by  the  secretary-general  to  the  Servian  foreign 
minister  (Appendix  I)  the  total  of  the  various  heads  under  which  war 
expenditure  is  classified  amounts  to  but  fr.  445,880,858,  a  reduction  of  fr. 
128,934,642  on  the  total  sent  in  to  the  Finance  Commission. 

In  the  absence  of  documents  it  is  to  be  presumed  that  Montenegro  can- 
not have  spent  fr.  103,000,000  even  if  its  reserves  were  possible  in  the 
country  requisitioned.  (194,  pp  260-261)  (See  table  next  two  pages.) 


[82] 


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HYGIENE     AND     WAR 

The  Balkan  wars  simply  emptied  the  factories  and  fields  of  their  male 
workers.  Out  of  2,632,000  inhabitants,  Greece  mobilized  210,000  men; 
Bulgaria  620,657  out  of  its  4,319,108  inhabitants;  and  Servia  467,630  men 
out  of  2,945,950  inhabitants.  The  result  was  a  considerable  deficit  in  the 
taxes  collected,  a  falling  off  in  the  state  receipts.  We  will  quote  the  example 
of  only  one  country,  Servia,  the  same  phenomenon  having  occurred  to  the 
same  extent  in  the  other  belligerent  countries.  Servia  experienced  the 
following  variations  in  its  monetary  resources.  Taxation  produced  2,879,- 
577  dinars  in  the  month  of  October,  1913,  against  591,315  in  the  correspond- 
ing period  of  1912,  and  5,817,493  in  1911;  that  is,  an  increase  in  1913  of 
2,188,251  dinars  on  the  results  of  1912. 

In  the  first  ten  months  of  the  year  1913,  taxation  which  had  brought 
in  33,911,817  dinars  in  1911,  and  24,443,984  dinars  in  1912,  only  brought 
in  10,623,800  dinars.  The  decrease  of  13,820,184  dinars  between  the  figures 
for  1913,  and  those  for  the  year  before,  is  explained  by  the  peculiar  circum- 
stances. In  1912,  the  taxes  were  in  fact  regularly  paid  for  the  first  nine 
months,  whereas  during  the  greater  part  of  the  corresponding  period  of 
1913,  Servia  was  in  a  state  of  war. 

Then,  too,  war,  besides  depriving  states  of  their  ordinary  receipts,  causes 
the  heavy  expenditure  on  armaments,  ammunition,  and  equipment; 
.  .  .  (194,  pp.  259-260) 

Finally,  the  Balkan  states,  immediately  after  the  war,  took  up  the  posi- 
tion of  conquerors;  in  Belgrade,  in  Athens,  and  in  Sophia,  the  sovereign 
and  the  troops  made  triumphal  entries. 

Today  the  Balkan  states  are  acting  as  beggars.  They  are  seeking  to 
borrow  money  to  pay  their  debts  and  build  up  again  their  military  and  pro- 
ductive forces. 

Such  is  the  result  of  war.  Hundreds  of  thousands  of  deaths,  soldiers 
crippled,  ruin,  suffering,  hatred,  and  to  crown  all,  misery  and  poverty  after 
victory.  War  results  in  destruction  and  poverty  in  every  direction.  (194, 
p.  264) 

These  conditions,  existing  at  the  close  of  the  Balkan  wars, 
are  not  being  recovered  from  in  the  present.  Again  are  these 
regions  the  scene  of  conflict,  carnage,  and  devastation.  The 
hatreds,  etc.,  so  well  described  by  the  Commission,  are  now 
expressing  themselves  in  the  part  these  nations  are  taking  in 
the  present  great  conflict.  We  have  shown  in  a  previous 
section  the  awful  lack  of  physicians,  not  merely  to  take  care 
of  the  troops  but  to  look  after  the  civilian  population.  The 
long-continued  drain  upon  Servia,  for  example,  has  involved 
far  more  than  the  number  previously  mentioned  as  mobilized 
for  the  Balkan  wars.  Perhaps  the  following  statement  attri- 


HYGIENE     AND     WAR 

buted  to  Prince  Regent  Alexander  is  more  literally  true  than 
estimates  usually  are: 

Rome,  March  20,  1915.  Servia  has  lost  nearly  1,000,000  of  her  5,000,000 
people  through  death  by  sword,  through  starvation,  or  in  the  typhus 
epidemic.  .  .  .  The  remaining  4,000,000  face  starvation. 

Such  devastation  gives  rise  to  economic,  social,  and  physical 
losses,  human  and  brute,  that  are  irremediable. 

The  Cost  of  the  Spanish-American  War. — But  let  us  consider 
the  losses  nearer  home  in  a  struggle  that  as  a  war  ranks  as 
a  very  minor  affair  indeed.  So  little  have  we  been  informed 
of  its  cost  that  few  realize  the  load  that  it  has  placed  upon 
us,  not  only  in  problems  of  military  policy  with  reference  to 
the  remainder  of  the  world  but  in  the  mere  fact  of  the  cost 
of  living  now.  Our  abominable  system  of  indirect  taxation 
to  which  we  cling  with  almost  fetishistic  worship  prevents,  in 
many  cases,  a  true  appraisement  of  the  real  cost  to  the  com- 
munity and  the  individual. 

The  war  with  Spain  for  the  liberation  of  Cuba  was  entered  into  from 
patriotic  motives,  and  may  have  been  inevitable.  It  was  lawfully  declared 
by  Congress,  and  was  marked  by  few  of  the  necessary  barbarities  of  warfare. 
The  destruction  of  the  two  sections  of  the  Spanish  navy  marked  the  change 
in  naval  warfare  in  which,  while  the  admiral  or  commander  of  the  fleet  has 
the  opportunity  to  display  judgment  and  courage,  yet  in  the  actual  attack 
he  must  of  necessity  become  the  subordinate  of  the  engineers  who  work  the 
machinery.  In  neither  engagement  was  there  any  equal  contest,  only  an 
example  that  the  man  behind  the  guns  must  not  only  have  the  courage 
which  is  a  common  attribute,  but  the  greatest  technical  skill  and  practice 
in  the  working  of  complex  mechanism.  In  fact,  in  the  engagements,  the 
Spaniards  showed  the  high  courage  of  their  race  in  a  hopeless  struggle  to 
meet  the  superior  skill  and  mechanism  of  their  opponents.  (9,  p.  150) 

The  present  conflict  is  emphasizing  the  truth  of  the  above 
quotation.  All  the  glamour  of  contest  is  removed  from  present 
war,  thus  preventing  the  functioning  of  those  factors  so  often 
credited  with  the  power  of  bringing  out  the  best  in  men.  At 
the  present  time,  war  is  an  encourager  of  fatalism.  It  should 
also  be  recalled  that  this  same  fleet  which  proved  so  superior 
had  been  and  was  at  that  time  decried  as  inefficient,  inade- 

[86] 


HYGIENE     AND     WAR 

quate,  with  the  same  sort  of  vehemence  and  lamentation  as 
that  employed  by  the  present-day  advocates  of  military  pre- 
paredness in  the  United  States. 

From  an  investigation  "compiled,  computed,  and  proved 
from  the  official  reports  of  the  government,"  Atkinson  esti- 
mates the  cost  of  war  and  warfare  from  1898  to  1902  inclusive 
at  twelve  hundred  million  ($1,200,000,000)  dollars. 

COMPARISON  OF  PER  CAPITA  EXPENDITURES 

(9,  p.  148) 


All 
Expen- 
diture 

Civil 

Army 

Navy 

Inter- 
est 

Pen- 
sions 

1878  to  1898  [20  years 
of  peace]  

$S.oo 

$1.48 

$0.75 

$0.^5 

$i  go 

$2  A.2 

1898  to  1902  [5  years 
of  war] 

667 

i  5^ 

I  05 

086 

O  J.7 

2  11 

•^•00 

Variation,  1898-1902 

+$1.67 

+$0.05 

+$1.20 

+$0.51 

—$1.43 

$0.09 

Excess  of  the  cost  of  war  and  warfare  over  normal  rates  of  peace  com- 
puted at  $2.50  per  head  year  by  year. 


[87] 


HYGIENE     AND     WAR 


COMPARISON  OF  FIVE  YEARS  OF  WAR  ON  THE  NORMAL  RATE 

OF  $2.50  PER  HEAD  IN  TIME  OF  PEACE  WITH  INTERESTS 

AND  PENSIONS  ACTUAL 

(9,  P-  149) 


1898 

1899 

1900 

1901 

1902 

Normal  cost,  government  
Pensions  End  interest  

$2.50 

2.40 

$2.50 
12.42 

$2.50 

2.^7 

$2.50 
2.21 

$2.50 

2.1  1 

Estimated  normal 

$4.00 

$4.Q2 

$4.87 

$4.71 

$4  61 

ACTUAL  

6.08 

8.14 

6.39 

6.57 

5.96 

+$1.09 

+$3.22 

+$L52 

+$i.86 

+$1-35 

[88] 


HYGIENE     AND     WAR 


RELATIVE  TAXATION  IN  THE  UNITED  KINGDOM,  FRANCE, 

AND  GERMANY,  AS  COMPARED  TO  THE  UNITED  STATES 

(9,  pp.  168-169) 

From  a  similar  official  statement  of  the  national  expenditures  of  the 
republic  of  France,  the  following  computations  are  derived  for  the  year 
1901: 

FRANCE 


Population  

38  600  ooo 

Total 

Per 

capita 

Civil  and  judicial  service 

QH  6  390  696 

$?  oo 

Army,  navy,  public  works,  forts,  etc  

2'*4,Q2S.682 

6  10 

Interest  on  public    debt  and    pensions,  omitting 
workmen's  old-age  pensions  . 

257  608  ^8l 

6  67 

Expenditures  for  state  manufactures,  subsidies  to 
merchant  marine,  to  free  art  schools  and  to  four 
religious  cults,  etc.,  carry  the  per  capita  to  over 

$608,924,759 

$15-77 
$17.00 

GREAT  BRITAIN 

From  an  official  statement  of  the  expenditures  of  the  United  Kingdom  of 
Great  Britain  and  Ireland,  the  following  computations  are  derived  for 
the  year  ending  March  31,  1901: 


Population  computed  at  

41,500,000 

Total 

Per 

capita 

Expenditures  for  civil  and  judicial  services,  omit- 
ting imperial  taxes  appropriated  to  local  pur- 
poses   

$ii4,4=;7,86o 

$  2  76 

Army  and  navy  under  normal  conditions  of  peace 
Interest  on  national  debt  and  pensions  

230,159*880 
134,330,400 

5-54 

^.24. 

The  special  war  expenditures  of  the  year  are  esti- 
timated  at  

$478,948,140 
•317  1  1  6  460 

$ii.54 
7.64 

Total 

$796  1  1  6  600 

$IQ  18 

[89] 


HYGIENE     AND     WAR 

In  the  present  year  this  burden  will  be  somewhat  lessened,  but  by  com- 
parison with  the  United  States  fiscal  year,  ending  June  30,  1901,  the 
British  rate  is  $19.18  per  head  against  the  United  States  rate  of  $6.57,  now 
also  lessened  (1905). 

The  author,  in  absence  of  official  statements  of  expendi- 
tures, estimated  the  per  capita  expenditure  of  Germany  at 
$12.00.  He  says: 

Twelve  dollars  in  Germany  falls  on  a  per  capita  product  not  over  half 
our  own;  $17.00  in  France,  on  a  product  not  over  three-fifths;  $11.54  to 
$13.00  in  the  United  Kingdom  in  time  of  peace,  $17.00  in  time  of  war,  on 
a  product  per  capita  not  over  three-quarters,  if  as  much. 

The  nemesis  of  the  rule  of  blood  and  iron — revanche,  junkerism,  and 
militarism — hangs  like  a  pall  over  continental  Europe,  and  the  words 
'Disarm  or  starve1  are  written  upon  the  battlements  on  land  and  on  the 
battleships  upon  the  sea. 

This  being  the  condition  at  that  time,  the  awfulness  of  the 
present  conflict  should  impress  itself  upon  us  with  greater 
vividness. 

COST   PER  CAPITA  OF  THE   GOVERNMENT   BY  TERMS   OF 

ADMINISTRATION 

(9,  P-  155) 

President  Hayes $5.21 

President  Arthur 4.73 

1878  to  1897      <  President  Cleveland 4.43 

inclusive         j  President  Harrison 5.36 

President  Cleveland 5.18 

Average  of  twenty  years  of  peace,  order,  and  industry $5.00 


MILITARY  EXPENDITURES 
(9,  p.  156) 


1878  to  1897 


President  Hayes $o .  77 

President  Arthur o .  80 

President  Cleveland o .  66 

President  Harrison o .  76 

President  Cleveland o .  77 


Average  of  twenty  years  of  peace,  order,  and  industry $o .  75 

[90] 


HYGIENE     AND     WAR 


NAVAL  EXPENDITURES 

(9,  P-  157) 

/ President  Hayes $0.31 

\  President  Arthur o .  29 

1878  to  1897  /President  Cleveland 0.24 

I  President  Harrison o .  42 

\  President  Cleveland 0.44 

Average  of  twenty  years  of  peace,  order,  and  industry. . .  $0.35 

SUMMARY  OF  TWENTY  YEARS  OF  PEACE 
(9,  P-  159) 


President 

Civil 

Mili- 
tary 

Naval 

Total 

1878  to  1897 
inclusive 

Average 

/  Hayes  

$1-33 
1-45 
143 
1.66 

1.48 

$0.77 
0.80 
0.66 
0.76 
0.77 

$0.31 
0.29 
0.24 
0.42 
0.44 

$2.41 
2-54 
2-33 
2.84 
2.69 

\Arthur 

/Cleveland  

/Harrison 

\Cleveland  

$148 

$0.75 

$0.35 

$2.58 
0.08 

$2.50 

Less  non-recui 
Normal  rate 

Tent  items 

As  the  author  points  out,  the  cost  of  the  navy  which  con- 
quered and  destroyed  the  Spanish  fleets  is  included  in  this 
period. 

Continuing  the  discussion  of  his  data,  Atkinson  states  (9, 
p.  177): 

The  estimates  in  that  treatise  have  been  more  than  justified  by  the  official 
statements  of  the  Secretary  of  the  Treasury  in  his  computations  of  the 
expenditures  to  June  30,  1904,  by  which  it  appears  that  the  average  per 
head  of  the  present  year  will  be  $6.29. 

It  also  appears  that  the  estimates  presented  by  the  departments  for  the 
fiscal  year  ending  June  30,  1905,  if  not  exceeded,  will  be  $6.76. 

The  actual  difference  between  the  normal  rate  previous  to  the  Spanish- 
American  War  and  the  average  of  $6.58  for  seven  years  of  active  and  passive 
war  and  warfare  would  be,  per  head,  $1.58  (italics  author's). 

[91] 


HYGIENE     AND     WAR 

But  during  the  eight  years  of  Harrison  and  Cleveland  the  annual  cost 
of  pensions  and  interest  was,  per  head,  $2.50. 

In  the  fiscal  year  ending  June  30,  1903,  pensions  and  interest  were  less 
per  head,  than  $2.00.  Reduction,  $0.50. 

Both  charges  are  now  rapidly  diminishing,  and  the  normal  cost  of  govern- 
ment, without  war  and  warfare,  in  1903  and  1904,  estimated  at  $6.29, 
would  not  have  exceeded  $4.29  on  a  basis  of  peace,  order,  industry,  and  good 
government,  economically  administered. 

The  cost  of  passive  war  and  warfare  is  now  over  two  dollars  per  head,  now 
being  assessed  on  nearly  82,000,000  people,  or  over  $160,000,000. 

On  the  3Oth  of  June,  1904,  the  cost  of  war  and  warfare,  active  and  passive, 
will  have  been  $1,000,000,000  and  even  if  the  appropriations  for  the  year 
1905  are  not  exceeded  at  the  end  of  the  fiscal  year,  it  will  have  been 
nearly  $1,200,000,000. 

We  may  take  off  $100,000,000  for  expenditures  now  being  made  for  a 
useful  purpose  which  were  not  made  before  the  Spanish  War,  such  as  irriga- 
tion, national  parks,  the  expansion  of  the  Department  of  Agriculture,  and 
the  possibility  that  the  consular  service  may  be  reorganized,  with  suitable 
compensation  to  competent  men.  .  .  . 

The  total  expenditures  during  the  four  years  of  the  Civil  War  and  the 
four  subsequent  years  of  reconstruction,  fiscal  years  June  30,  1862,  to  June 
30,  1869,  inclusive,  were  a  small  fraction  over  four  thousand  nine  hundred 
million  ($4,900,000,000)  dollars  stated  in  the  Treasury  Report.  But  it  must 
be  observed  that  all  the  supplies,  armaments,  and  construction  of  vessels 
during  that  period  were  paid  in  the  depreciated  paper  money,  the  issue  of 
which  caused  a  very  great  advance  in  prices.  Many  years  since  I  made  a 
close  estimate  of  the  additional  cost  of  the  Civil  War  which  could  be  attrib- 
uted to  the  depreciation  of  legal  tender  notes.  I  made  it  out  about 
one  thousand  million  ($1,000,000,000)  dollars,  a  very  conservative 
estimate. 

We  may  deduct  from  the  gross  sum  of  the  expenditures  during  the  Civil 
War,  and  the  period  of  reconstruction  seven  hundred  million  ($700,000,000) 
dollars,  bringing  the  total  cost  on  a  gold  basis  to  forty-two  hundred  million 
($4,200,000,000)  dollars. 

The  expenditures  for  the  same  specific  purposes  for  the  eight  years  of  war 
and  warfare,  June  30,  1898,  to  June  30,  1905,  on  actual  figures  and  appropri- 
ations, will  have  been  the  same  sum,  namely,  forty-two  hundred  million 
($4,200,000,000)  dollars.  (9,  pp.  201-202.) 

The  figures  emphasize  not  only  the  extreme  financial  cost 
of  our  petty  struggle  with  Spain  but  also  show  how  enor- 
mously the  cost  of  carrying  on  such  procedures  is  increasing. 

Who  Pays  the  Cost? — This  should  be  self-evident.  Ever  and 
ever  it  is  he  who  is  least  able,  the  laboring  man  and  woman. 

[92] 


HYGIENE     AND     WAR 

The  working  groups  of  the  country  consists  of  a  fraction  under  three, 
one  person  occupied  for  gain  supporting  two  others  as  well  as  himself  or 
herself.  The  average  product  of  each  person  occupied  for  gain  is  approxi- 
mately seven  hundred  dollars  a  year;  that  is  a  rather  large  estimate.  It 
follows  that  three  persons  must  get  their  support,  pay  their  taxes,  make 
their  contributions  to  savings,  and  get  their  board  and  clothes  out  of  what 
seven  hundred  ($700.00)  dollars  a  year  will  cover,  deducting  taxes,  i.e., 
on  what  $225  a  year  will  buy  at  retail  for  each  person. 

It  follows  that,  if  the  cost  of  the  war  for  five  years  (1898  to  1902  inclusive) 
had  been  over  $700,000,000,  then  work  equivalent  to  that  of  one  million 
men  for  one  year  has  been  diverted  from  the  productive  pursuits  of  peace 
to  the  destructive  pursuits  of  war. 

Divide  this  number  by  five  and  we  get  the  work  annually  of  two  hundred 
thousand  (200,000)  men  each  year  for  five  years,  during  which  period  we 
may  have  had  an  average  of  one  hundred  thousand  (100,000)  men  under 
arms  by  land  and  sea,  thus  developing  the  common  rule  that  for  every 
man  taken  from  productive  industry  into  the  army  and  mavy  the  work  or 
product  of  one  other  man  must  be  diverted  to  the  destructive  purpose  of  war. 

This  is  the  economic  aspect  of  war — justifiable  for  defensive  purposes; 
criminal,  brutal,  and  barbarous  when  waged  for  offensive  purposes  or  for 
the  expansion  of  trade  by  conquest  or  colonization.  (9,  p.  153) 


[93] 


J 


IV.     THE  CIVILIAN  POPULATION  AND  WAR 

SUFFERING   OF   NON-COMBATANTS 

Loss  Not  Confined  to  Armies. — But  not  alone  does  the  army 
suffer  from  diseases.  These  are  carried  by  the  soldiers  to  the 
civilians  among  whom  they  wreak  havoc.  Likewise,  invading 
armies  are  subjected  to  all  the  bad  conditions  of  the  population 
and  territory  they  invade.  Syphilis  was  probably  introduced 
into  Europe  by  Columbus  on  his  return  voyage  from  America, 
spread  by  Karl  VIII  through  Italy,  and  thence  scattered 
throughout  southern  Europe.  Though  there  is  some  ques- 
tion, it  is  also  probable  that  leprosy  was  spread  by  the  Cru- 
sades. In  1864  venereal  cases  among  Prussian  troops  rose 
from  24  per  thousand  in  time  of  peace  to  164  in  time  of  war. 
The  rate  in  Bavaria  rose  from  1.56  per  cent,  in  1864  and  1.43 
per  cent,  in  1865  to  3.29  per  cent,  in  1866.  Plague  occurs  with 
singular  regularity  in  connection  with  wars.  (212)  It  needs 
but  a  momentary  consideration  of  the  nations  involved  in 
the  present  war  to  show  that  many  diseases  among  the  troops 
will  spread  through  the  territories  they  now  occupy,  and  in 
their  native  lands  upon  their  return. 

It  is  impossible  to  confine  the  loss  to  the  armies  involved. 
The  entire  population  of  the  countries  at  war,  suffers  pro- 
portionately. Strange  as  it  may  seem  the  deaths  due  to 
worry,  overwork,  starvation,  deprivations,  etc.,  among  the 
women,  children,  and  those  left  at  home  closely  approximates 
those  of  the  soldiers.  By  no  juggling  of  data,  is  it  possible 
to  get  around  the  fact  that  the  best,  the  fittest,  of  the  popula- 
tion are  lost  and  can  not  be  replaced.  War  by  no  means  pro- 
vides for  the  survivial  of  the  fittest.  At  the  same  time  we 
should  remember  that  the  loss  in  any  one  year  due  to  pre- 
ventable epidemic  and  infectious  diseases  among  civilians  is 
greater  than  the  loss  from  war,  especially  from  bullets.  This 
should  cause  the  employment  of  the  same  vigorous  hygienic 
and  sanitary  measures  in  times  of  peace  as  in  times  of  war. 

[94] 


HYGIENE     AND     WAR 

Data  Inadequate. — Statistics  relative  to  civil  conditions  dur- 
ing times  of  war  have  been  meager  and  unreliable,  owing  to 
the  fact  that  all  the  machinery  of  government  is  busy  with 
war  affairs.  Hence  facts  concerning  the  condition  of  the 
people  themselves  in  war  times  are  hard  to  obtain.  It  is 
hoped  that  the  organization  of  the  governments  involved  in 
the  present  struggle  is  such  that,  at  its  conclusion,  we  shall 
have  sufficient  data  to  give  us  the  exact  condition  of  the 
people  involved  during  and  at  the  close  of  the  conflict. 

Indicative  of  what  a  prolonged  war  may  do  are  the  follow- 
ing statements:  (212)  During  the  Thirty  Years'  War,  the 
population  of  Bohemia  was  reduced  from  4,000,000  to  800,000; 
in  many  regions  of  Germany  today  the  population  has  not 
reached  the  status  prior  to  that  war;  the  number  of  inhabi- 
tants of  Wurtemberg  sank  from  313,000  in  1634  to  65,000  in 
1645;  the  average  reduction  was  one-fourth  of  the  popula- 
tion at  the  beginning  of  the  war;  of  80,000  in  Augsburg  in 
1632,  there  were  but  18,000  in  1648;  in  Frankenthal,  of 
18,000  but  324  remained.  The  Napoleonic  wars  carried 
disease  to  such  an  extent  that  the  death  rate  exceeded  the 
birth  rate. 

Effect  of  General  Sanitary  Conditions. — As  pointing  to  the 
interaction  of  health  conditions  in  the  army  and  in  the  land 
occupied  and  invaded,  it  may  be  mentioned  that  the  British 
expeditionary  force  in  the  West  has  suffered  little  from  epi- 
demic diseases.  There  have  been  a  few  cases  of  enteric  among 
the  Belgians.  Cholera,  smallpox,  and  dysentery  were  not 
found  up  to  December  6,  1914.  But  the  influx  of  Belgian 
refugees  gave  rise  to  new  problems.  Verminous  conditions 
and  venereal  diseases  had  given  trouble  in  places.  The  High- 
land and  Island  troops  suffered  considerably  from  measles. 
In  Austria  and  Servia,  cholera  and  typhus  have  been  increas- 
ing at  such  a  rate  as  to  cause  apprehension.  Unemployment, 
misery,  sickness,  ever  follow  in  the  wake  of  war.  It  is  there- 
fore necessary  that  civilians  follow  the  same  rigid  observance 
of  sanitation  and  hygiene  as  the  army  in  the  field  and  in  camp. 
(366,  368,  374) 

[95] 


HYGIENE     AND     WAR 

Home  Must  not  be  Neglected  for  War. — War  serves  merely  to 
emphasize  the  extraordinary  necessities  forced  upon  us.  It 
may,  in  its  usurpation  of  all  of  our  energies,  undo  the  work 
of  years.  Already  in  Germany,  England,  and  Servia  a  warn- 
ing note  is  being  sounded  relative  to  the  neglect  of  those  left 
at  home.  So  many  physicians  and  nurses  have  been  called 
to  the  front  that  medical  care  and  inspection  of  people,  schools, 
factories,  etc.,  is  being  omitted.  This  will  not  do,  for  the 
future  of  the  nation  depends  upon  the  young — the  children 
at  home.  It  is  true  the  authorities  are  awakening  to  the 
danger  and  are  making  efforts  to  meet  it.  It  is  to  be  hoped  the 
general  public  will  rally  to  their  aid — inadequate  though  all 
effort  must  prove  under  the  stress  of  war.  (3,  13,  38,  102, 
133,  147,  158,  197,  211,  325,  369,  374) 

Dr.  R.  P.  Strong  of  the  Servian  Sanitary  Commission  states 
that  at  the  beginning  of  the  war,  there  were  360  doctors  in 
Servia,  of  whom  121  have  since  died  (April  29,  1915)  leaving 
239.  To  these  250  foreign  physicians  may  be  added,  giving 
a  total  of  509  for  a  population  of  5,000,000.  As  the  army  takes 
all  the  time  and  energy  of  this  limited  number,  the  women 
and  children  and  the  men  at  home  are  untreated  and  neglected. 

(228) 

German  Views  on  School  Hygiene  in  War. — As  showing  the 
correlation  of  school  hygiene  with  that  of  the  army  and 
general  public,  we  can  do  no  better  than  give  views  of  some 
German  writers  in  the  midst  of  the  conflict.  Dr.  Julius  Moses 
calls  attention  to  the  fact  that  many  of  the  excellent  German 
schoolhouses,  owing  to  previous  hygienic  administration  by 
the  school  department,  have  been  made  into  hospitals.  He 
points  out  that  school  hygiene,  which  is  scarcely  more  than 
forty-four  years  old,  is  being  subjected  to  the  test  of  fire  and 
is  proving  its  worth;  for  the  excellent  condition  of  the  men 
in  the  field  is  due  to  their  school  training.  Thus  war  is  prov- 
ing that  hygiene,  taught  and  practised  in  years  of  peace,  not 
only  functions  then,  but  now  during  the  war.  He  empha- 
sizes the  fact  that  the  war  has  demonstrated,  contrary  to  the 
opinion  of  some,  that  the  youth  of  today  are  not  effeminate 

[96] 


HYGIENE     AND     WAR 

nor  weakened.  "What  the  present  youth  shows  in  contrast 
to  the  earlier  generations,  is  a  high  degree  of  sensitivity 
(Reizsamkeit),  that  is,  a  sensitive  reaction  of  the  nerves  and 
a  finer  adjustment  of  the  mind  to  mental  and  moral  influ- 
ences." This  sensitivity  is  one  of  the  most  potent  factors 
making  for  modern  culture.  Social  hygiene  has  been  and 
must  continue  to  be  considered  in  relation  to  school  hygiene. 
In  fact  this  will  be  one  of  the  great  problems  for  solution  at  the 
close  of  the  war.  (158) 

We  should  then,  this  writer  urges,  instill  into  the  minds 
of  the  youth,  the  necessity  of  cleanliness,  etc.,  that  they  may 
help  fight  the  contagious  and  infectious  diseases  in  the  home 
and  out  of  it.  We  should  emphasize  light,  air,  dustlessness, 
and  cleanliness.  In  order  that  best  results  may  be  obtained 
from  the  sick  and  wounded,  it  is  necessary  that  they  have 
knowledge,  discipline,  and  strength  of  will  to  obey  medical 
instructions.  And  here  drill  from  school  hygiene  functions. 
It  is  for  those  who  have  to  remain  at  home  to  see  that  all  the 
elements  of  German  culture  are  preserved  through  the  school 
and  otherwise. 

Along  similar  lines  is  the  discussion  of  school  hygiene  in 
time  of  war  by  Dr.  Adolph  Baginsky.  He  indicates  that  many 
of  the  special  institutions  for  the  care  of  children,  etc.,  have 
been  turned  over  to  the  war  department  for  military  use. 
In  view  of  the  increased  work  of  the  mothers,  it  will  be  neces- 
sary for  many  of  the  children  to  be  taken  care  of,  not  merely 
during  the  day  but  also  during  the  night.  Kindergartens 
may  do  this  to  some  extent.  It  is  important  that  wash  and 
bath  facilities  be  provided.  Children  who  stay  for  nights 
should  have  undisturbed  sleep.  Of  course,  cleanliness  must 
be  maintained  and  the  nourishment  of  the  children  carefully 
watched.  In  striking  contrast  with  the  views  of  those  Ameri- 
can teachers  and  writers  who  would  inject  the  war  into  the 
curriculum  at  every  possible  point  is  the  opinion  of  this 
hygienist  that,  "The  less  disturbance  the  school  suffers  from 
military  procedure — the  less  it  is  observed  in  school — the 
better."  The  school  must  make  allowance  for  the  increased 

[97] 


HYGIENE     AND     WAR 

irritability  in  children  whose  fathers  are  away  at  the  front, 
who  are  performing  strenuous  duties  by  reason  of  this  absence 
etc.  Baginsky  asks,  "Is  there  a  war  psychosis?  Does  it 
spread  from  house  to  house,  from  family  to  family?"  It  is 
to  be  expected  that  this  tense  period,  this  excitable  state, 
will  be  accompanied  by  hallucinations,  etc.  (13) 

It  is  then  the  duty  of  teachers  properly  to  direct  these 
forces  at  work.  They  should  watch  the  nervous  children. 
They  should  protect  the  child  from  fatigue,  from  too  much 
home  work,  from  school  tenseness  and  school  discipline  and 
from  idle  street  life.  It  will  be  necessary  to  provide  school 
feeding  more  and  more.  Baginsky  does  not  favor  a  system 
of  gymnastics  built  on  military  lines.  He  thinks  the  English 
ideals  of  sport  are  better  and  give  the  best  results. 

Even  though  in  the  stress  of  war,  Germany  must  consider 
not  only  making  the  youth  healthy  and  strong,  but  also  the 
treatment  of  children's  diseases,  writes  Dr.  Altschul.  No 
present  means  of  treatment — forest  and  open  air  schools,  etc. 
— should  be  omitted.  Though  the  question  of  a  decreasing 
birth  rate  due  to  war  is  mooted,  the  fact  remains  that  it 
will  be  necessary  to  recruit  the  army  from  the  coming  genera- 
tion. (3) 

In  the  rush  of  women  to  be  nurses,  to  take  care  of  the  sick, 
etc.,  they  should  not  forget  that  the  greatest  benefit  for  the 
country  is  yet  to  be  found  in  the  proper  care  of  its  young. 
Germany  must  take  care,  in  the  economy  which  must  be 
practised  at  this  time,  that  she  does  not  make  the  children 
suffer  and  thereby  impair  the  prospects  of  good  future  citizens. 
Dr.  Altschul  urges  that  the  mothers  and  babies  must  be  taken 
care  of.  Teachers  should  post  themselves  on  proper  hygiene 
and  cooperate  with  the  physicians.  Nurses  and  women  who 
volunteer  should  be  requisitioned  for  work  with  the  children. 
Teachers  should  give  instruction  and  training,  especially  of 
the  body,  through  all  sorts  of  exercises,  games,  etc.  He  sug- 
gests that  inattention  is  often  a  symptom  of  illness.  Soon 
a  large  number  of  orphans  must  be  cared  for  and  when  these, 
at  the  age  of  fourteen  become  more  or  less  free,  another  large 

[98] 


HYGIENE     AND     WAR 


problem  will  confront  Germany.  He  suggests  that  possibly 
these  may  be  taken  care  of  in  rural  colonies  thus  educating 
the  children  and  at  the  same  time  giving  help  to  the  country 
workers.  He  points  out,  too,  that  the  weak,  the  defectives, 
etc.,  cannot  receive  the  attention  needed.  He  concurs  with 
Baginsky  in  advising  the  non-emphasis  of  war  in  the  school 
curriculum.  It  is  well  to  avoid  making  too  strenuous  appeals 
to  the  imagination  of  pupils  in  these  stirring  times,  espe- 
cially at  the  age  of  puberty. 

FOOD 

Kinds  and  Amount. — Quoting  from  Parkes,  Woodhull  (259) 
gives  the  following  ration  requirement : 


Garrison 

Field 

Albuminates  (flesh) 

oz. 

A     "\l 

6-7 

Hydrocarbons  (fats)  

T.     Z1. 

•7      C—  A      5 

Carbohydrates  (starch  and  sugar) 

II    71 

16-18 

Salts  . 

I    IO 

I    2—1     ^ 

20.65 

26.7-31 

99 


HYGIENE     AND     WAR 

The  following  is  a  ration  suggested  by  medical  officers: 


Proposed 


Now  used 


oz.  oz. 

Fresh  beef  or  other  fresh  meat 20  20 

or  Salt  beef 20  22 

or  Pork  and  bacon 12  12 

Flour 22  18 

or  soft  bread 22  18 

except  on  fatigue  when  F.  or  S.  Br 24 

or  hard  bread 16  16 

and  flour 4.8 

or  corn  meal 24  20 

Beans  or  peas 2.4  2.4 

or  money  value  in  milk,  fresh,  canned,  cheese 

Potatoes,  60  pounds  to  100  rations 9.6  16 

or  value  in  fresh  or  dried  fruit 

Rice 1.6  1.6 

or  value  in  fresh  vegetables 

Sugar 2.4  2.4 

Coffee,  green 1.6  1.6 

or  roasted 1.28  1.28 

or  tea o .  24  o .  24 

In  addition  the  soldier  should  have  candles,  soap, 

pepper,  etc 3.5  3.5 


We  find  divergence  in  statistics  offered  as  to  present  army 
rations.  One  writer  in  World's  Work  gives  the  following  (365) : 


Russian  • 
French  - 
English  - 
German  • 
Austrian- 


-4929  calories 
-3340  calories 
-3292  calories 
-3147  calories 
-2620  calories 


He  also  states  that  the  American  and  British  rations  are 
about  the  same,  being  as  follows:  Bread  I  pound,  meat 
without  bone  ^4  pound,  preserved  17  ounces,  12  cents  per  day 
mess  allowance.  He  also  points  out  the  necessity  for  proper 

[100] 


HYGIENE     AND     WAR 

amount  of  water.  The  evaporation  of  each  2  grams  of  water 
extracts  I  calorie  of  heat  from  the  body.  As  approximately 
90  calories  of  energy  are  used  in  a  mile  march,  180  grams  of 
water  are  evaporated  or  used.  In  a  6-mile  tramp  this  amounts 
to  1^4  pints,  about  1-40  of  body  weight.  He  further  points 
out  that  every  pound  added  to  the  load  carried  increases 
the  energy  expenditure  at  the  rate  of  4.5  calories  (small)  per 
minute. 

The  following  is  stated  to  be  the  war  prisoner's  ration  in 
England:  Bread  i}4  pounds,  or  biscuits  I  pound,  fresh  or 
frozen  meat  8  ounces  or  preserved  y£  ration,  fresh  vegetables 
8  ounces,  butter  or  margarine  I  ounce,  tea  ^  ounce  or  coffee 
I  ounce,  sugar  2  ounces,  salt  ]/2  ounce. 

For  the  purpose  of  obtaining  a  proper  ration,  the  British 
experimented  with  two  sets  of  men.  In  the  first  experiment 
were  20  volunteers  and  4  officers  of  the  R.  A.  M.  Corps  who 
practised  marching  in  October  during  which  there  was  con- 
tinuous rain.  Their  ration  consisted  of  fresh  beef,  whole  meal 
biscuits,  bread,  a  vegetable  ration,  jam,  sugar,  salt,  and  tea. 
The  total  energy  value  was  3,465  calories,  slightly  less  than 
the  Atwater  standard  for  moderate  work,  1,000  less  than  for 
hard  work  and  750  less  than  is  supplied  convicts  at  hard 
labor.  The  health  of  the  men  was  good  throughout  the  experi- 
ment. For  the  last  five  days  the  average  loss  in  the  men  was 
but  */2  pound,  and  in  officers  ^.  It  was  calculated  that  men 
lost  approximately  62  grams  fat  and  170  grams  flesh  during 
the  last  five  days.  (355) 

From  this  experiment  it  was  decided  that  3,465  calories 
are  not  enough — that  there  should  be  from  4,500  to  5,000  for 
large  men. 

In  the  second  experiment  20  men  under  command  of  one 
officer  were  used.  By  adding  cheese  and  bacon  to  the  ration, 
the  number  of  calories  was  increased  to  4,511.  At  the  con- 
clusion of  the  time,  the  men  were  in  fine  condition,  not  hungry, 
and  had  gained  in  weight. 

From  these  facts,  they  infer  that  the  field  ration  should 
give  4,500  calories,  and  hence  be  about  3  pounds. 

[101] 


HYGIENE     AND     WAR 

The  following  ration  (345)  shows  selection  of  part  of  the 
home  British  force: 

Fresh  or  preserved  meat I  lb. 

Bread I  lb. 

or  biscuit  $4,  or  flour  I  lb. 

Bacon 2  oz. 

Tea,  y2  oz.',  sugar,  2  oz.;  salt,  X  oz.;  mustard,  1/20  oz.;  pepper,  1/36  oz., 
In  lieu  of  %  lb.  of  bread,  may  have  I  oz.  cheese,  I  oz.  jam,  and  cash  allow- 
ance for  food  of  I  YI  d.  per  day. 

Major  Lelean  reports  that  the  field  ration  of  3,900  calories 
used  by  the  British  has  been  found  insufficient  and  that  they 
are  now  using  4,855.  He  states  that  where  food  value  is  too 
low,  debility  and  neurasthenia  results.  He  presents  the  fol- 
lowing table  for  comparison: 

Calories        In  Field  Reserve 

French 3,064       (  175  grams       1 80  grams  Protein  \ 

Field  ration  of     Russian 4,890       <  218  80  Carbohydrates  S 

1913  and  now  German... .     2,801       \  515  326  Fat  / 

English 4,855       4,855  calories  2,800  calories 

He  states  that  chocolate  has  proven  thirst-provocative 
rather  than  quenching.  (133,  ch.  I) 

All  writers  point  out  the  necessity  for  variety. 

In  the  use  of  tinned  foods,  demanded  by  the  exigencies  of 
war,  extreme  care  should  be  used.  The  exterior  of  the  can 
should  be  observed  and  labeled  plainly  with  contents  and  date 
of  canning.  It  should  have  not  more  than  two  solder  holes, 
with  its  ends  concave  and  giving  forth  a  dull  percussion.  The 
presence  of  a  small  amount  of  gas  can  be  detected  by  opening 
under  water.  Under  no  circumstances  should  the  tin  show 
erosion,  nor  should  the  solder  project  over  the  seams. 

Excess  in  eating  may  lead  to  biliousness,  forms  of  dyspepsia, 
and  excessive  waste.  Excessive  waste  irritates  the  kidneys, 
and  may  cause  gout,  obesity,  hardening  of  the  arteries.  Beefy 
men,  over-fed,  are  subject  to  apoplexy. 

Cooking  of  Foods. — The  soldier  should  be  able  to  cook  his 
own  food.  He  should  avoid  fads  and  extreme  Fletcherization. 
The  cooking  for  the  soldier  is  governed  in  general  by  the  same 
principles  as  for  the  civilian;  that  is,  variety  and  assimila- 

[102] 


HYGIENE     AND     WAR 

bility  should  be  considered.  Appetite  juice  is  a  valuable  asset 
in  the  diet.  For  this  reason  the  mincing  machine,  kept  thor- 
oughly clean,  has  proven  valuable  in  the  present  war.  (133) 

Keefer  suggests  as  the  general  diet  the  following:  Milk, 
eggs,  and  beef,  the  latter  to  be  avoided  when  of  dark  purple 
color  or  odorous.  It  should  not  be  excessively  soft  or  sticky. 
Bacon  and  meat  juices  and  powders  (extracts)  may  be  used. 
Under  stress,  horseflesh,  dogs,  and  even  rats,  have  been  eaten. 
Flour  bread  is  good  but  should  be  well  prepared.  Beans, 
rice,  potatoes,  sugar,  fruits,  tea,  and  coffee  are  included  in  his 
list.  Cocoa  might  well  be  added.  Of  the  various  ways  of 
preparing  meat,  he  names  the  following  which  should  be  used 
in  variation  as  much  as  possible:  stewing,  boiling,  roasting, 
broiling,  frying,  broths,  and  soups.  Vegetables  should  be 
cooked  with  caVe.  In  all  cooking  the  temperature  should  be 
kept  fairly  low — 170  deg.  Fahr.,  except  for  the  brief  interval 
at  the  starting  of  the  process.  Infection  should  be  prevented 
as  typhoid,  tuberculosis,  tapeworm,  trichinosis,  glanders,  and 
ptomaine-poisoning  may  result  from  infected  food.  Scurvy 
and  beri-beri  result  from  faulty  diet.  The  former  is  due  to 
lack  of  organic  matter  in  the  food.  The  latter  is  due  to  the 
loss  through  excessive  milling  of  the  vitamines  contained  in  the 
outer  layers  of  the  rice.  Scurvy  may  be  alleviated  by  adding 
%  ounce  of  lime  juice  to  the  food  daily.  Coarse  milled  rice 
will  prevent  beri-beri.  (116,  133,  ch.  I) 

The  problem  of  the  transportation  of  food  is  a  great  one 
in  the  present  war.  It  is  for  this  reason  that  much  of  it  has 
to  be  handled  as  canned  goods.  But  the  commissary  depart- 
ments have  proved  efficient  and  the  extreme  need  of  having 
well-fed  soldiers  has  been  recognized  so  thoroughly  by  the 
commanders  that  so  far  there  is  little  complaint  in  this  respect. 
Where  the  invading  force  attempts  to  subsist  on  the  food  of 
the  conquered  sections,  still  more  care  has  to  be  exercised. 
But  the  present  campaigns  are  on  such  a  stupendous  scale 
that  little  dependence  can  be  placed  on  such  food  supplies. 

Civilian  Food  in  War-Time  England. — The  matter  of  food 
supply  is  one  of  significance  not  only  to  the  soldier  but  to 


HYGIENE     AND     WAR 

the  civilian.  All  energies  are  bent  toward  the  purposes  of 
war.  Hence  any  drain  on  forces  which  might  be  employed 
in  its  furtherance  tend  to  defeat  its  end.  The  food  of  the 
country  invaded  must  be  conserved,  not  only  for  its  soldiers 
but  for  all  its  inhabitants.  The  food  in  the  country  of  the 
invader  must  be  economized  so  that  the  savings  thereby  may 
be  used  in  furtherance  of  invasion  or  conquest. 

We  can,  therefore,  easily  understand  the  emphasis  which 
Great  Britain  is  putting  upon  this  subject  throughout  the 
kingdom.  Though  a  largely  importing  country  and  insular, 
she  is  able,  through  her  navy  and  colonies,  to  obtain  food. 
Yet  this  is  at  some  risk,  and  every  ship  used  for  the  protection 
of  food  supply  means  necessarily  so  much  energy  diverted 
from  the  conduct  of  war. 

It  has  been  pointed  out  by  one  writer  that  the  prices  indicate 
that  England  will  not  suffer  for  want  of  food  for  some  time. 
But,  nevertheless,  it  is  necessary  to  practise  'national  economy' 
and  prevent  'individual  hoarding'.  He  tells  that  at  the  begin- 
ning of  the  war  the  'better-to-do  people'  carted  off  more  food 
than  they  needed.  But  the  government,  with  the  assistance 
of  the  board  of  trade,  put  a  stop  to  this  and  also  succeeded, 
moderately  well,  in  preventing  unnecessary  rise  in  price.  He 
urges  that  the  population  must  be  conserved  and  that  to  do 
this  housing  and  food  must  be  looked  after.  It  is  essential 
that  air,  light,  warmth,  and  food  be  provided.  (340,  341, 

342,  343) 

In  this  plan  of  economy,  it  has  been  suggested  that  the 
consumer  must  be  protected  from  short  weight,  etc.  It  was 
recommended  that  tea,  coffee,  powdered  cocoa,  should  be 
sold  by  'net  weight';  that  bread,  except  that  known  as  'fancy 
bread',  should  also  be  sold  by  exact  weight.  The  quality  of 
the  flour  used  in  making  the  bread  should  govern  to  some 
extent  its  price.  Gluten  gives  elasticity  to  the  flour.  The 
presence  of  so-called  'improvers  of  flour'  in  the  form  of 
mineral  phosphates  increases  the  weight  by  increasing  the 
amount  of  water  absorbed  without  adding  anything  to  the 
value  of  the  bread.  (343,  344) 

[104] 


HYGIENE     AND     WAR 

Since  part  of  the  usual  food  supply  will  be  limited  owing  to 
dangers  and  difficulties  of  importation,  not  to  mention  cost, 
it  is  necessary  to  form  and  find  substitutes.  It  will  be  neces- 
sary to  get  all  possible  nourishment  out  of  everything.  Sim- 
plicity of  diet  with  as  much  variety  as  possible  is  the  watch- 
word. No  longer  must  the  Englishman  look  with  contempt 
upon  hashes  and  stews.  Owing  to  the  large  number  of  men 
away  at  the  front,  the  harvest  may  be  impaired.  More  bread, 
cheese,  and  butter  should  be  used.  One  writer  says,  "It  is 
of  interest  to  add  that  in  the  great  textile  trades,  big  stocks 
of  low-grade  wheaten  flours  are  kept,  which  are  employed  for 
sizing  the  fabrics  in  conjunction  with  the  use  of  'loading' 
materials;  as,  for  example,  china  clay."  At  this  critical  time, 
this  starch  supply  must  be  reserved  for  human  food. 

As  the  food  most  expensive  and  hardest  to  import  contains 
the  proteid  element,  it  will  be  necessary  to  seek  substitutes. 
Hence  pulses,  peas,  lentils  made  into  soups,  puddings,  etc., 
should  be  employed.  Chestnuts,  bananas,  and  maize  should 
find  wider  use.  To  supply  the  deficit  of  butter  the  'drippings' 
from  meat  should  be  saved  and  used.  Fish,  chiefly  herring, 
kipper,  and  bloaters,  must  take  the  place  of  beef  to  a  large 
extent.  It  is  well  known  that  the  English  civilian  and  soldier 
uses  'jam'  and  marmalade  extensively.  This  furnishes  part 
of  the  needed  sugar  supply.  Pamphlets,  circulars  and  lec- 
tures are  being  given  throughout  Great  Britain  on  such  topics 
as:  'Foods  to  Buy  During  the  War',  'The  Highest  Nutritive 
Value  at  Lowest  Cost',  'The  Preservation  of  Food',  etc.  (347) 

Germany's  Food  Supply  in  War  Times.  (226) — Strauss  claims 
that  the  peasants  of  Germany  are  better  fed  now  than  in  peace 
times.  Far  more  care  has  to  be  used  in  choice  and  preparation 
of  food.  He  says  the  educated  classes,  so-called,  do  not  need 
to  be  considered,  as  their  number  and  condition  is  such  that 
they  are  not  obliged  by  prices  to  curtail  their  usual  supply. 
They,  in  fact,  do  not  seem  to  realize  that  importation  is  limited. 
He  states  that  some  of  the  sick  should  go  on  an  anti-fat  diet. 
For  the  diabetic,  oils,  nuts,  and  cheese  will  furnish  the  neces- 
sary fat.  Protein  may  be  obtained  from  smoked  fish.  He 

[105] 


HYGIENE     AND     WAR 

urges  the  more  extensive  use  of  skim  milk.  Dyspeptics  may 
use  potato  flour  cooked  in  skim  milk.  Rice,  cocoa,  and 
chocolate,  he  points  out,  are  already  becoming  scarce  in 
Germany. 

Germany  exports  rye,  and  imports  eggs,  wheat,  milk,  and 
cream.  This  importation  being  very  limited,  it  is  necessary 
for  each  German  to  do  without  a  small  amount.  It  is  sug- 
gested that  the  lack  of  30,000  pounds  of  butter  from  Russia 
annually  means  but  a  slight  deprivation  on  the  part  of  each 
German.  One  of  her  writers  states  that  owing  to  the  war  she 
is  losing  annually  from  importation : 

from  Argentina,  America,  and  Australia. .      18,000  tons  beef  and  mutton 

from  England 50,000  tons  herring 

from  Russia,  amount  not  known legumes 

from  India 215,000  tons  India  rice 

total  loss  from  importation  of 3,000,000  tons  wheat 

total  loss  from  importation  of 250,000  tons  fat 

This  may  be  offset  by  retention  of  her  own  sugar,  600,000  tons. 

He  urges  that  Germany  cease  to  distill  potatoes,  for  this 
vegetable  is  the  mainstay  under  the  present  circumstances. 
The  troops  should  be  more  abstemious.  There  is  a  deficit 
in  the  amount  of  food  present  to  feed  cattle  and  swine,  which 
will  make  some  adjustment  necessary  in  the  raising  of  these. 
It  is  from  six  to  eight  million  tons.  (337) 

Oppenheim  writes  that  the  number  of  cattle  slaughtered 
(in  Germany)  should  be  proportioned  to  some  extent  to  the 
amount  of  fodder  available.  He  suggests  that  probably  10 
per  cent,  of  the  milk  cows  and  35  per  cent,  of  the  swine  will 
have  to  be  killed.  Fourteen  per  cent,  of  the  horses  of  the 
farmers  have  been  commandeered  for  use  of  the  army  up  to 
January,  1915.  The  places  of  these  animals  will  have  to  be 
taken  by  oxen,  in  some  cases  by  cows  and  motors.  The 
motor  plow  will  be  used  more  than  ever,  and  alcohol  will  have 
to  be  used  as  a  fuel.  This  will  probably  have  to  be  obtained 
from  the  distillation  of  potatoes.  He  points  out  that  a  motor 
plow  requires  300  kilos  starch  value  per  day  and  does  the 
work  of  twenty-eight  men.  Twenty-eight  oxen  require 

[106] 


HYGIENE     AND     WAR 

400  kilos  and  more  human  assistance  than  does  the  motor 
plow.  (336) 

A  serious  problem  is  that  of  securing  proper  fertilizers. 
Chile  saltpeter  is  no  longer  available  and  the  phosphates  are 
lacking. 

It  is  necessary  to  use  every  bit  of  wheat  for  bread,  not  for 
starch  or  alcohol. 

Rubner  presents  the  following  data :    (200) 

CONSUMPTION  OF  MEAT  FOR  IQI2 

Germany     52.3  kilogram  per  head  Austria      29.0  kilogram  per  head 

England      47.6  kilogram  per  head  Russia       21.8  kilogram  per  head 

France         33.6  kilogram  per  head  Italy  10.4  kilogram  per  head 

He  suggests  that  while  unable  to  get  eggs,  poultry,  or  fish 
from  Russia,  they  can  obtain  the  latter  in  large  amounts  from 
neutral  countries.  He  thinks  rye  will  make  up  for  rice  and 
wheat. 

A  more  careful  study  of  the  care,  preparation,  and  use  of 
the  potato  should  be  made.  The  vast  waste  due  to  spring 
rot  must  be  avoided.  He  states  that  only  28  per  cent,  of  the 
potato  crop  has  been  used  for  the  table,  4.6  per  cent,  has  been 
distilled,  and  50  per  cent,  used  for  fodder.  A  wider  use  of 
potatoes  should  be  made  in  soups,  purees,  etc. 

It  will  be  necessary  in  some  way  to  make  up  for  3,500,000 
tons  of  cheap  fodder  imported  annually.  He  would  main- 
tain the  stock  of  milk  cows  at  all  hazard.  Let  the  people 
economize  on  butter.  Should  each  German  stint  himself  but 
one  gram  per  day,  it  would  release  for  other  uses  300,000 
milk  cows. 

From  what  has  preceded  it  is  easily  seen  that  should  Ger- 
many run  short  of  food,  it  will  be  largely  in  those  products 
furnishing  the  protein. 

Salkowski  estimates  the  per  diem  consumption  of  protein 
in  Germany  before  the  war  as  92.9  grams  of  which  25  per  cent, 
was  imported.  If  the  German  should  depend  upon  his  home 
market  alone,  he  would  have  67.2  grams.  The  amount  neces- 

[107] 


HYGIENE     AND     WAR 

sary  is  64.6  grams.  It  is  seen  that  if  the  country  practises 
economy  she  can  get  along.  In  confirmation  of  this  position 
he  states:  (204) 

Chittenden  places  the  minimum  at  51  grams. 
Pfliiger,  Bohland,  Bleiblau,  at  80  to  90  grams. 
Hirschfeld,  Hundhede  experiments,  at  25  to  44.36  grams. 
Salkowski's  experiments,  at  42.41  grams. 

The  experiments  with  dogs  seem  to  indicate  that  low  protein 
diet  results  in  sensitivity  to  tuberculosis  and  infectious  dis- 
eases. The  facts  show  that  both  low  and  high  protein  diet 
are  bad.  He  states  that  'war  bread'  is  deficient  in  protein; 
that  milk,  skim  milk,  and  cheese  are  rich  in  protein;  that 
potatoes  are  poor  in  this  element;  and  that  legumes  are  rich 
in  it.  However,  only  part  of  the  latter  is  available  as  there 
is  from  30  to  40  per  cent,  waste.  This  may  be  overcome  by 
making  flour  from  beans,  peas,  etc.  The  author  claims  the 
waste  can  thus  be  reduced  to  12  per  cent. 

He  would  have  the  people  use  the  blood  of  slaughtered 
animals  on  a  far  more  extensive  scale  than  hitherto.  "The 
use  of  blood  soup  seasoned  with  vinegar  (the  blood  cooked 
with  dried  fruit)  could  be  made  more  general."  "To  prepare 
blood  for  food,  take  coagula  produced  by  heating  the  dilute 
fluid,  dehydrate  with  alcohol  or  ether,  dry  in  the  air,  and 
grind  into  a  fine  powder." 

Kloss  states  that  resistance  to  disease  is  not  merely  a  matter 
of  germ  infection  but  of  general  bodily  tonus  and  that  one 
of  the  most  important  factors  in  this  is  nourishment.  He 
points  out  that  the  danger  of  infection  during  war  time  is 
especially  great  and  therefore  the  food  should  be  cooked 
wherever  possible,  not  eaten  raw.  (123) 

One  of  the  most  careful  and  thorough  of  German  writers 
on  the  subject  of  the  food  supply  of  the  German  people  is 
Dr.  Paul  Eltzbacker  who  alone  and  in  collaboration  with 
others  has  put  forth  the  conditions  to  be  met  and  suggestions 
for  meeting  them.  We  shall  therefore  present  in  outline,  as 
extracted  from  one  of  his  papers  or  pamphlets  of  some  200 
pages,  its  content. 

Fio8l 


HYGIENE     AND     WAR 

THE  FOOD  SUPPLY  OF  THE  GERMAN  PEOPLE 

(53,  54,  55,  346) 

Chapter  I.          The  Problem  of  an  Isolated  Political  Economy. 

a.  The  starvation  plan  (as  the  Germans  view  the  Eng- 

lish blockade). 

b.  Germany  a  closed  economic  area. 

c.  The    isolated    political    problem;     i.e.,    problem   of 

political  isolation  is  a  new  one. 

Chapter  II.        The  Reduction  of  the  Food  Supply. 

1.  Reduced  imports — 10,000,000  tons  import  of  fodder, 

for  example,  has  ceased. 

2.  Home  production  of  food  stuffs: 

North  Sea  fisheries  reduced  to  a  minimum. 
Agriculture  suffers  from  lack  of  laborers,  horses, 
manures,  etc. 

Chapter  III.      The  Food  Requirements  of  the  German  People. 
I.  Aim  of  nutrition: 

i  gram  of  fat  gives  9.3  calories. 

I  gram  of  carbohydrate  gives  4.1  calories. 

proteid  lacking. 

2.  Requirement  in  calories  of  German  people  per  year 

proportionate   to   age,   sex,    work.     About    56.75 
billion  calories  needed. 

3.  Proteid  requirement  must  be  worked  out  separately. 

Voit  held  body  of  70  kilos  requires  105  grams  of 

proteid  daily. 
Neuman  held  (in  1902)  body  of  70  kilos  requires 

71  grams  of  proteid  daily. 
Schumburg  (1873)  held  body  of  70  kilos  requires 

60  grams  of  proteid  daily. 
Good  average  is  3,000  calories,  total  70  grams  of 

proteid   daily.    About    70  grams    forms    about 

9.6  per  cent,  of  total  food. 

Chapter  IV.       The  Actual  Consumption  of  Food  by  the  German  People 
before  the  War. 

I.  Ascertain  the  quantity: 

The  present  rate  of  consumption  would  give  90.42 
billion    calories,    totaling    2,307   thousand   tons 
proteid. 

The  actual  physical  requirements  of  68  million 
people  are  56.75  billion  calories,  totaling  1,605 
thousand  tons  proteid. 

[109] 


HYGIENE     AND     WAR 

The  consumption  exceeds  actual  needs  59  per  cent. 

Nutritive  value  44  per  cent,  proteid  excess. 

Annual  home  production  (1912-1913)  was  71.24 
billion  calories,  that  is,  1,636  thousand  tons 
proteid. 

Thus,  if  Germany  continues  at  rate  of  consumption 
in  vogue  preceding  war,  she  will  show  under 
such  regime  under  war  conditions  a  deficit  of 
25  per  cent,  of  total  food  stuffs  and  33  per  cent, 
proteid. 

While  it  is  possible  to  have  19  per  cent,  more  than 
physical  requirements,  there  will  still  be  lack 
of  3  per  cent,  proteid  and  this  deficit  will  tend 
to  increase. 

2.  Storage. 

3.  Adaptation  of  production: 

Use  ground  for  most   nutritive  vegetables,  beets, 

potatoes,  etc. 

Put  unused  and  unoccupied  ground  to  use. 
Use   different    materials   for    fodder   (potato  tops 

have  been  suggested). 
Use  every  food  as  directly  as  possible  for  man  and 

thus  save. 

4.  Adaptation  of  habits  of  life. 

5.  Means  of  carry-ing  out  the  necessary  measures: 

a.  New  laws. 

b.  Careful  administration. 

c.  Instructions  of  people  through  press,   unions, 

agricultural  societies,  school,  lectures,  etc. 
May  be  necessary  to  fix  prices  by  law. 

Chapter  VI.       The  Prohibition  of  Export. 

1.  Grain. 

Author  says  2,500  wagons  of  grain  which  should 
have  been  kept  at  home  were  sent  through  mis- 
take to  Switzerland.  (However,  facts  seem  to 
show  that  this  was  already  property  of  Swiss, 
merely  in  course  of  transit  through  Germany 
and  in  no  proper  sense  a  legitimate  part  of 
German  food  supply.) 

Denmark  has  prohibited  export  of  barley  to 
Germany. 

2.  Sugar. 

[no] 


HYGIENE     AND     WAR 

Chapter  VII.     Agriculture. 

1.  Crops  to  be  chosen. 

In  1912-1913  Germany  imported  251,000  tons  of 
peas,  28,000  tons  of  lentils,  31,000  tons  of  beans, 
2,000,000  tons  of  wheat.  She  exported  1,100,000 
tons  of  beet  sugar  and  600,000  tons  of  rye. 

Nature  of  exports  suggests  the  growing  of  pulses, 
beet  sugar,  etc.,  to  supply  deficiency. 

2.  Seed  corn. 

3.  Labor  and  traction. 

They  expect  prisoners  of  war  to  supply  part  of 
labor;  will  have  to  break  the  colts  to  work  ear- 
lier, use  bulls  and  oxen,  perhaps  cows,  to  take 
place  of  14  per  cent,  horse  deficit. 

Use  steam  and  motor  plows  and  machinery  where 
possible. 

Use  benzol  instead  of  petrol  oil. 

Use  coke  instead  of  coal. 

4.  Manures. 

Care  must  be  exercised  in  storing,  to  keep  out  the 
air.  It  is  claimed  that  the  keeping  up  of  the 
*  potato  yield  proportionate  to  the  increase  in 
population  is  due,  50  per  cent,  to  artificial  ma- 
nures and  30  per  cent,  to  better  selection  of  seed. 

Conserve  and  use  with  judgment,  nitrogen,  phos- 
phoric acid,  potash,  and  chalk. 

5.  Culture  of  moors. 

20,000  sq.  kilometers  of  usable  land  said  to  be  idle 
in  Germany. 

Stretch  of  land  on  both  sides  of  the  Hamburg- 
Bremen  railroad  could  be  used. 

Must  have  more  intensive  cultivation. 

Chapter  VIII.   Live  Stock. 

i.  There  will  have  to  be  a  reduction  in  the  number  of 
cows  and  pigs.  In  fact,  there  must  be  a  general 
reduction  in  the  number  of  beasts. 

The  government  has  forbidden  the  use  of  bread- 
corn  as  fodder;  this  amounts  to  2,000,000  tons 
in  rye  alone,  yearly. 

Breeding  will  have  to  be  limited. 

'The  pig  is  greatest  food  competitor  of  man'. 
In  feeding  a  pig  weighing  from  15  to  120  kilos, 
24  per  cent,  of  proteid  and  44  per  cent,  of  total 
food  given  to  it  are  retained  for  man's  use  as  food. 

[ml 


HYGIENE     AND     WAR 

In  calf  of  from  30  to  360  kilos,  but  20  per  cent, 
proteid  and  14  per  cent,  total  food  value  are  thus 
retained.  While  in  a  milk  cow  weighing  500 
kilos  and  giving  2,200  liters  milk  per  year,  36 
per  cent,  of  proteid  and  24  per  cent,  of  total  food 
fed  are  retained  for  man's  use. 

It  is  then  seen  that  milk  cows  should  be  retained 
as  much  as  possible. 

2.  Degree  of  limitation  of  number  of  beasts: 

For  every  3^  pigs  destroyed  one  cow  may  be 
retained;  that  is,  a  reduction  of  9,000,000  pigs 
should  increase  the  number  of  cows  retained  by 
4,000,000  or  a  reduction  of  35  per  cent,  of  pigs 
result  in  10  per  cent,  increase  of  cows. 

3.  The  carrying  out  of  the  reduction. 

Slaughter  poor-producing  cows  first,  but  gradually. 
Retain  pigs  only  so  long  as  there  is  no  other  use  for 
skim  and  buttermilk. 

4.  Small  live  stock. 

Poultry,  etc.  Not  much  to  be  expected  here  under 
war  stress. 

5.  Increase  production  of  fodder. 

Leaves  of  beet  and  potato  may  be  used;  these 
should  be  harvested  and  preserved. 

Much  of  the  green  stuff  ordinarily  plowed  in  may 
be  used  for  fodder,  such  as  Chinese  radish,  white 
mustard,  peas,  etc. 

Chapter    IX.    The  Proper  Utilization  of  Agricultural  Products. 

1.  Corn  and  potatoes. 

Beet  parings  are  usable.  Rice  and  maize  no  longer 
available.  In  1911  34,000  tons  of  rice  and 
25,000  tons  of  maize  were  used.  Must  find 
substitutes  for  these.  Should  replace  wheat 
starch  with  potato  starch.  Avoid  use  of  starch 
on  linen,  etc.  Limit  the  use  of  potatoes  in  the 
making  of  alcohol.  Do  not  use  grains  for  alcohol, 
i.e.,  rye,  wheat.  Utilize  every  part  of  wheat 
and  rye,  bran,  etc.,  in  bread.  Use  potato  in 
making  potato  bread. 

Bread  should  contain  a  minimum  of  10  per  cent. 
rye  and  5  per  cent,  potato.  It  is  possible  to  dis- 
pense with  yeast. 

2.  Vegetables  and  fruits. 

Use  edible  fungi. 

[112] 


HYGIENE     AND     WAR 

Storage,  pickling,  drying,  preserving, — topics  that 
should  be  studied. 

3.  Sugar. 

Use  it  in  preserving  fruit. 

Use  surplus  as  fodder. 

Use  sugar  in  the  form  of  molasses  to  make  other 
materials  palatable  to  beasts,  e.g.,  with  beet 
parings. 

For  milk  cows,  per  1,000  kilos,  it  is  advisable 
to  use  10  kilos  of  beets;  for  cattle,  per  1,000 
kilos,  15  kilos  of  beets;  for  horses,  per  1,000 
kilos,  8  kilos  of  beets;  for  sheep,  per  1,000 
kilos,  25  kilos  of  beets;  for  pigs,  per  1,000 
kilos,  25  kilos  of  beets. 

4.  Milk. 

"Full  milk  is  to  be  retained  in  its  present  quantity, 
production  of  cream  and  butter  is  to  be  limited, 
cheese  is  to  be  produced  where  possible  in 
increased  quantity.  From  the  skim  milk 
remaining  after  making  butter,  cheese  (curds 
and  skim)  is  to  be  made  as  far  as  possible  and 
the  direct  use  of  skim  milk  is  also  to  be  en- 
couraged by  propaganda  and  cheap  prices." 

5.  Meat  and  fat. 

Germany  must  reckon  with  the  fact  that  pigs  are 
to  be  reduced  1/3  and  cows  i/io.  This  will 
temporarily  increase  amount  of  meat  on  market. 
Must  slaughter  and  store  carefully  and  properly. 

The  farmers  should  themselves  prepare  and  smoke 
hams,  bacon,  etc. 

Limit  the  use  of  fat  for  technical  purposes  as  in 
soaps. 

Chapter    X.     The  Necessary  Alteration  in  Habits  of  Life. 
I.  Must  use  more  vegetable  food. 

Must  use   food  materials  now  in  abundance,  i.e., 

in  excess. 

Must  limit  proteid  consumption,  and  diminish  it. 
Relative  Consumption  of  Meat  per  Head : 


Year 

Kilos 

Year 

Kilos 

1818 

13-6 

1883 

29-3 

1840 

21.6 

1892 

32.5 

1861 

23.2 

1900 

43-4 

1873 

29-5 

1907 

46.2 

113 


HYGIENE     AND     WAR 

The  increased  production  of  linseed  oil,  beechnuts, 
sunflower  seeds,  etc.,  may  help  a  little.  It  has 
been  suggested  that  the  use  of  fat  incites  to  the 
use  of  alcohol.  Hence  limitation  of  former  tends 
to  limit  latter. 

2.  Meat,  fish,  milk,  cheese,  skim  milk,  pulses. 

3.  Bread,  porridge,  puddings,  potatoes,  vegetables. 

4.  Fruits,  sugar. 

"Exact  investigations  have  shown  that  taking 
some  12  to  15  grams  of  sugar  in  half-hourly 
intervals  can  remove  the  sense  of  fatigue  in 
very  large  measure." 

Sugar  does  not  produce  thirst.  Germans  should 
use  it  more  in  tea  and  coffee. 

5.  Household  Economy. 

Substitute  puddings  for  meat  at  the  midday  meal. 
Do  not  eat  between  meals. 

Marmalade  may  be  used  with  profit  instead  of  fat. 
Do  not  use  butter  when  you  are  eating  ham  and 

bacon. 
Watch  marketing.     Avoid  waste.     Economize  on 

soap,   needing  fat   for  other  purposes.     Watch 

home  cooking. 
For  breakfast  use  rolls;  for  dinner  large,  loose  rye 

or  rye  and  wheat  flour;  for  supper  the  same. 


[114] 


HYGIENE     AND     WAR 
Chapter     XI.     Results: 

THE   COVERING   OF   THE   DEFICIT 


Nutritive  Value 

Proteids 
in 
thousands 
of  tons 

Calories 
in 
milliards 

1,605.0 

57.7SO.O 

Actual  use  before  the  war          

2,307.0 

90,420.0 

Available   if  the   present   conditions   remain   un- 
altered                               

1,543.0 

67,860.0 

To  add;  through  alteration  of  cattle  keeping  
through  prohibition  of  corn  as  fodder.  .  .  . 
through  avoidance  of  waste 

217.3 

78.3 
80.0 

2,878.0 
2,741.0 
5,675.0 

through  increased  use  of  skim  milk  and 
skim  cheese 

48.8 

250.9 

-through  potato  drying     

18.9 

1,112.3 

through  limitation  of  butter  production  .  . 
through  cultivation  of  moors 

14.8 
10.4 

110.4 
592.O 

through    prohibition    of    production    of 
alcohol  from  corn                                 .  .  • 

4.7 

68.6 

through  preserving  vegetables  

3.6 

93-0 

through  preserving  fruits      

1.7 

147.5 

through    prohibition    of    production    ol 
wheat  starch       

1.3 

5.2 

Subtract  Sugar  used  as  fodder  (thousand)  

283.1 

AVAILABLE,    if   the    means   recommended   are 
carried  out  

2,022.8 

81,250.8 

The  author  considers  this  estimate  a  most  conservative  one, 
based  on  the  lowest  figure,  under  highest  expenditure  and 
worst  conditions.  When  it  is  borne  in  mind  that  the  German 
army  is  away  from  home,  on  a  foreign  soil  from  which  it 
draws  a  large  part  of  its  sustenance,  the  sick  and  children 
being  counted  as  consuming  the  same  as  normal  adults,  it  is 
easily  inferred  that  the  prospects  of  being  able  to  take  care 
of  herself  for  some  time  are  good  in  Germany. 

In  other  articles,  Dr.  Eltzbacker  has  suggested  changes  in 
procedure  which  will  help  the  Germans.  He  points  out  that 


HYGIENE     AND     WAR 

it  is  best  to  peel  potatoes  after  cooking  rather  than  before, 
and  to  be  careful  in  this  process,  for  it  is  possible  to  avoid 
thereby  an  annual  loss  of  one-half  million  tons.  Germans 
should  also  use  more  sugar.  He  states  that  the  consumption 
of  this  in  the -United  States  and  England  is  twice  that  per 
head  in  Germany. 

Schwalbe  gives  the  following  concrete  suggestions  to  the 
German  people  as  to  their  menus  during  war  time:  (210) 

For  their  first  and  second  breakfasts: 

Rye  bread  eaten  with  jam  or  soft  cheese.    Omit  meat. 
Sweetened  decoctions  of  oat  meal  or  barley  may  be  used  as  beverages 
and  also  to  substitute  in  part  for  bread. 

For  their  mid-day  meal: 

Soups,  containing  legumes,  scraps  of  meat,  and  potato. 

Wheat  flour,  porridge  made  with  skim  milk. 

Potatoes,  cabbage,  beets,  turnips,  green  beans,  etc.,  may  be  cooked 

together  with  a  little  fat  meat. 
Sour  kraut  cooked  with  pea-porridge,  white  beans  with  prunes,  potatoes 

with  dried  apples  or  prunes. 
Noodles  eaten  with  fruit  jam,  dumplings. 
All  kinds  of  cereals  cooked  in  skim  milk  and  highly  sweetened. 
Use  cheaper  fish,  herring,  etc. 
Fruit  stews,  tomatoes,  etc.,  as  relishes. 

For  supper: 

Rye  bread  and  cheese  form  the  staple  food  for  this  meal. 

May  use  a  little  bacon  or  sausage  after  a  meatless  dinner. 

Baked  potatoes  eaten  in  the  skins,  with  herring  or  bacon  instead  of  butter. 

Children  must,  in  general,  eat  largely  of  cereals  cooked  in  skim  milk. 

Food  and  Fatigue. — Jacobi  has  pointed  out  that  there  are  two 
types  of  soldiers:  those  who  work  like  demons  and  are 
considered  heroes,  and  others  who  seem  to  let  up  and  are 
called  quitters.  These  same  types  exist  in  the  civilian  popu- 
lation. Upon  examination  it  is  often  found  that  the  second 
class  are  in  many  cases  half-fed  and  tuberculous  or  otherwise 
diseased.  He  says  "...  exhaustion  means  more  than  a 
high  degree  of  fatigue.  A  difference  here  obtains  in  regard 
to  protein  and  carbohydrates,  insufficiency  in  utilization.  If 
ordinary  energy-food  (carbohydrates)  is  not  available,  the 
organism  must  draw  upon  protein-food  and  protein  tissues 

[116] 


HYGIENE     AND     WAR 

for  energy  supplies.  This  means  exhaustion,  structural  and 
functional,  and  everything  short  of  this  situation  may  be 
conceived  as  some  degree  of  simple  fatigue."  The  author  is 
at  pains  throughout  to  discriminate  between  the  highest 
degrees  of  fatigue  and  exhaustion.  The  former  appear  to  be 
associated  with  a  particular  condition  of  the  circulation  which 
in  theory  should  respond  to  stimulation.  The  milder  degrees 
of  fatigue  may  be  offset  by  the  use  of  coffee,  tea,  cocoa,  kola, 
etc.  These  stand  in  close  relationship  to  the  xanthin  group. 
From  another  angle,  the  vascular  indication  may  be  filled  by 
suprarenin  and  hypophysin.  (105) 

School  Feeding. — In  Berlin  since  1907,  under  the  influence 
of  the  social  democratic  faction,  school  feeding  has  been  com- 
mon. It  is,  under  the  present  stress,  more  than  ever  neces- 
sary to  continue  this.  The  authorities  have  provided  that 
needy  children  shall  be  provided  with  a  warm  mid-day  meal 
which  may  be  procured  from  the  Union  for  Folk  Children's 
Kitchens.  The  city  charges  the  Union  12  pf.  for  each  portion. 
The  granting  of  such  free  food  is  not  considered  charity.  In 
one  yearly  statement,  it  was  found  that  22,000  marks  had 
been  thus  expended. 

In  August  1913  128,434  warm  mid-day  meals  were  given  needy  children. 
In  August  1914  251,000  warm  mid-day  meals  were  given  needy  children. 
In  Sept.  1913  144,000  warm  mid-day  meals  were  given  needy  children. 
In  Sept.  1914  547,000  warm  mid-day  meals  were  given  needy  children. 

HERE  ARE   SOME   SUGGESTED   MENUS   FOR  CHILDREN 

For  breakfast: 

Use  more  rye  bread  than  customary. 

Vary  by  having  a  little  wheat  (white)  bread. 

Some  butter,  lard,  use  more  marmalade,  less  sausage  and  more  cheese. 

It  is  unnecessary  to  have  meat  for  breakfast. 

Coffee,  tea,  cocoa,  with  abundance  of  sugar. 

Mid-day  meal: 

Cabbage  or  potato  soup  with  a  little  flesh  or  sausage. 
Grunkern,  barley,  pea,  bean,  lentil  soup,  all  mixed  with  potato. 

[117] 


HYGIENE     AND     WAR 

Meal  soup  with  skim  milk,  bread  soup  with  apples,  butter-milk  soup. 
Cabbage,  beets,  sugar  beets  with  much  potato  and  little  fatty  flesh. 
Sour  kraut  with  pea  broth. 

Sour  lentils  with  beans  and  plums  thoroughly  cooked  together  (dried 
plums). 

Potatoes  with  dried  plums  or  apples. 

Dumplings. 

Flesh  as  hitherto  but  not  daily.    Limit  its  use  to  the  growing  children. 

Herring,  dried  cod,  and  other  kinds  of  fish. 

Noodles  with  kraut  or  marmalade. 

Mehlspeisen  made  of  meal,  potatoes,  grits,  rice  mixed  with  little  egg  and 
plenty  of  sugar  or  skim  milk.  Complete  this  with  cooked  plums  or 
apples,  plum  marmalade,  tomatoes,  or  berry  juice. 

Alternate  the  meat  and  meatless  days,  using  more  meat  on  cold  days. 
On  the  fleshless  days  use  legumes  or  vegetables  with  skim  milk.  May 
use  beer  soup  with  bread  or  meal. 

For  supper: 

After  a  fleshless  dinner,  use  rye  bread  with  curd  or  other  cheese,  bacon, 
sausage  or  other  meat.  Warm  the  food  left  from  dinner  or  prepared 
warm  meal.  Potatoes  (peeling  on),  with  bacon  or  herring. 

Dumplings,  meal  pudding  with  sugar  and  skim  milk. 

After  a  flesh  dinner,  use  more  sugar;  after  a  meatless  dinner,  use  mere 
salty  food. 

For  children  there  should  be  numerous  broths  of  meal,  grits,  rice,  millet, 
buckwheat  prepared  with  milk.  (252) 

Objections  to  War  Bread. — As  pointed  out,  the  failure  of  Ger- 
many in  the  importation  of  wheat  has  forced  upon  her  the 
necessity  of  substitution.  For  these,  she  has  used  rye  and 
potato  flour  to  a  large  extent.  Objections  have  arisen  in  some 
quarters  to  the  exclusive  use  of  these.  Michaelis  condemns 
rye-flour-potato  bread  outright.  Fiirginer  believes  that  wheat 
and  rye  do  not  give  as  good  a  combination  as  wheat  and  potato 
flour.  Boas  thinks  that  the  digestive  troubles  attributed  to 
the  use  of  this  diet  are  due  as  much  to  the  nature  of  army 
life  as  to  war  bread.  Loeb  found  that  the  chyme  from  army 
bread  is  more  lumpy  and  frothy  than  normal.  (338,  339) 

fiiSl 


HYGIENE     AND     WAR 

But  the  complaints  have  been  comparatively  few.  The 
bakeries  have  been  seeking  to  make  this  rye  bread  digestible 
and  palatable. 

It  has  been  claimed  that  the  rye  bread  tends  to: 

1.  Set  up  diarrhoea,  a  result  of  fermentation  persisting  in  feces,  due  to 

some  extent  to  bolting  of  food.  May  remedy  this  by  eating  less  food 
and  thoroughly  masticating  what  is  eaten. 

2.  Set  up  hyperacidity.     The  unusual  pabulum  acts  upon  the  sensitive 

stomach  causing  it  to  secrete  acid  content  to  excess.  It  is  impossible 
to  do  away  with  this  as  the  stomach  will  not  become  adapted.  Bicar- 
bonate of  soda  in  small  doses  will  help. 

3.  Cause  flatulence.    This  is  the  commonest  ailment  from  eating  this  bread. 

Contrary  to  the  views  of  some,  it  is  not  due  to  mass  suggestion.  As 
the  soldiers  were  accustomed  to  fine  wheat  flour  which  they  do  not 
have  to  chew  much,  they  fail  to  chew  rye  bread  thoroughly,  especially 
when  it  is  fresh.  The  chyme  containing  particles  of  bread  is  then  in 
such  shape  that  it  can  not  be  dealt  with  by  the  pancreatic  amylose. 
These  particles  of  bread  become  seats  of  flora  cultures  in  the  intestines, 
while  the  cellulose  present  ferments.  Blood  charcoal  in  large  doses 
is  good  for  this. 

4.  Constipation.    This  is  rarely  found  and  is  perhaps  in  most  cases  due  to 

other  factors.    This  should  be  treated  by  giving  'feces  formers'. 

The  war  will  serve  to  teach  us  the  proper  foods  to  use, 
bring  out  types  neglected  hitherto,  give  lessons  in  prepara- 
tion,  care,  preservation,  and  economy.  Most  of  these  facts 
have  been  more  or  less  worked  out  in  times  of  peace.  Experi- 
mentation under  the  stress  of  war,  that  is,  the  use  of  the 
'trial  and  error  method',  is  dangerous  and  may  result  in  dis- 
aster. Should  a  large  portion  of  army  biscuits  be  poorly 
packed,  improperly  cooked,  or  infected,  the  injury  may  spell 
the  defeat  of  the  troops  at  the  front.  But  of  no  less  signifi- 
cance is  the  effect  of  such  experiments  at  home.  A  supply  of 
food  spoiled  through  any  of  the  factors  suggested,  means  an 
extra  tax  on  the  home  folk,  one  that  they  may  be  utterly 
unable  to  meet. 

Carefully  as  the  scientific  men  of  Germany  and  England 
have  worked  out  the  methods  of  meeting  the  conditions  facing 
them,  it  will  be  impossible  for  the  entire  nation  to  change 

[119] 


HYGIENE     AND     WAR 

the  habits  of  centuries  within  the  brief  space  of  time  neces- 
sary, hard  as  they  may  try,  and  sincere  as  they  may  be  in  their 
efforts  to  so  do.  Far  better,  far  surer,  is  the  gradual  habitua- 
tion  of  the  people  to  such  useful  habits.  This  is  possible  only 
in  years  of  peace.  A  glance  at  the  enormous  increase  in  the 
number  of  children  it  is  necessary  for  the  city  of  Berlin  to 
feed  will  indicate  how  stupendous  the  problem  of  proper  feed- 
ing, not  to  mention  food  supply,  may  become,  and  how  utterly 
impossible,  under  such  exigencies,  is  proper  training.  (68,  358) 

Facts  Showing  Stupendous  Task  in  Feeding  Imposed  by  War. — 
To  those  who  are  opposed  to  the  methods  of  propaganda,  the 
strenuous  efforts  made  by  military  men  and  civilians  in  publi- 
cations, leaflets,  lectures,  illustrated  and  otherwise,  to  instruct 
the  people  and  arouse  them  to  the  necessity  of  observing 
hygienic  laws,  of  eating  proper  food,  of  economizing,  etc.,  must 
be  rather  disquieting.  For  the  authorities  expect  this  train- 
ing to  function  and  it  apparently  has. 

Leaflets,  Lectures,  etc. — Germany  and  England  are  issuing 
leaflets,  scattered  through  the  schools  and  given  to  the  general 
public,  bearing  on  such  topics  as  'What  Food  to  Buy',  'How 
to  Live  Cheaply',  'Care  of  Food',  'How  to  Get  Rid  of  Ver- 
min', 'Typhoid',  etc. 

As  another  example  may  be  mentioned  the  Chadwick  Lec- 
tures on  'War  and  Diseases'.  One  of  these  dealt  with  develop- 
ment of  military  hygiene,  another  on  the  South  African  and 
the  Russo-Japanese  campaigns.  Such  are  being  distributed 
throughout  Great  Britain.  (205) 

As  indicative  of  what  is  being  done  in  Germany,  we  present 
the  essence  of  an  article  by  G.  Gohde  on  'Course  of  Instruction 
for  Public  Speakers  on  Nourishment  of  the  People  During 
War'.  (68) 

England  having  shut  Germany  off  from  outside  food  supply, 
it  behooves  the  people  of  the  latter  to  be  economical;  for 
every  bite  they  conserve  is  a  shot  at  England.  To  meet  the 
need  for  proper  instruction  in  economy,  lecture  courses  have 
been  established.  Through  these  it  is  hoped  to  tell  the  people 
what  to  eat  and  how  to  conserve. 

[120] 


HYGIENE     AND     WAR 

It  is  pointed  out  that  "No  one  needs  to  hunger  but  each 
must  economize.  Then  we  shall  have  enough  to  live  on — even 
through  a  long  war."  "Upon  the  participants  of  the  course, 
whom  the  minister  designates  the  home-army,  falls  the  prob- 
lem, and  truly  they  will  at  the  end  of  the  happy  and  victorious 
conclusion  be  able  to  say  that  they  have  contributed  to  the 
victory  of  the  great  national  cause." 

It  will  be  necessary  to  watch  and  regulate  farm  production 
and  especially  animal  production  and  use.  It  will  be  neces- 
sary to  take  extreme  care  of  the  milk  cows  and  calves,  for  the 
future  generation  must  be  assured  for  all  animals. 

The  first  lecture  dealt  with  'The  Real  War  Conditions  , 
the  second,  The  Nourishment  of  Man',  and  the  third,  'What 
We  Have  and  What  We  Lack'. 

The  average  consumption  for  the  last  two  years  of  peace 
per  head  has  been  210  grams  of  wheat,  175  grams  of  rye,  40 
grams  of  other  grains,  a  total  of  425  grams  of  which  35  grams 
were  imported.  Germany  now  lacks  barley  and  rice.  She  will 
have  to  depend  mostly  upon  potatoes,  and  be  more  careful  in 
their  use.  It  will  be  necessary  to  follow  a  more  strictly  vege- 
table diet. 

Of  150  grams  of  meat  and  fat  used  daily  per  head  15  grams  were  imported. 
Germans  used  daily  in  the  last  two  years  of  peace  per  head : 

350  grams  full  milk 
70  grams  skim  milk 
10  grams  buttermilk 
50  grams  goat's  milk 
20  grams  butter 
12  grams  cheese 

Probably  26  per  cent,  of  albuminous  material,  42  per  cent, 
of  fat  foods,  8  per  cent,  of  carbohydrates  and  20  per  cent,  of 
general  calories,  were  imported.  Thus  she  is  cut  off  from 
about  one-fifth  of  her  food  supply.  But  if  the  people  at  home 
will  hold  themselves  to  the  same  strict  discipline  as  the  army 
in  the  field,  the  country  will  come  through  all  right. 

In  the  second  session,  the  first  lecture  dealt  with  the  'Protec- 
tion Against  Losses'. 

[121] 


HYGIENE     AND     WAR 

VOLLMILCH     (68) 
Milk 


1 

1 

Sahne                        Sauermilch 

Vollfette  Kase 

Magermilch 

cream                        sour  (Kefir, 

Vollfette  Cheese     Skim  milk 

Yoghurt, 

Taette) 

Butter 

Buttermilk          Magerkas 

e          Q 

1 
uark          Molken 

K< 

isei 

Skim  cheese        curd             whe; 

f 

casein 

1 

Rohmilchzucker                Albumin 

raw  milk  sugar                      (Tabletten) 

1 

Milk  sugar  (chemically  pure) 
N.B. — By  cooking  with  a  weak  acid  or 
through    fermentation,    the    sugarmilk 
splits  into  galactose  and  dextrose. 


Milchzuckermelasse    (mother 
water,  bittern) 


Milchsaure  Kalk 
calcium  lactate 


Milchsaure  Milchsaueres 

Eisen 
Lactic  acid  Lactate  of  iron 

The  lecturer  pointed  out  that  it  was  necessary  to  cease  all 
exports  of  foodstuffs.  Through  friendly  consideration  toward 
the  Swiss,  2,500  wagons  of  grain  had  been  exported  to  them. 
But  this  was  hardly  advisable,  for  no  political  considerations 
can  substitute  for  the  means  of  subsistence.  Sugar  should  by 
no  means  be  exported.  More  care  should  be  exercised  in 
transportation  and  sale  of  products  in  order  to  diminish  losses 
due  to  these  factors.  In  this  connection  may  be  mentioned 
the  slaughter  of  hogs  which  give  only  24  per  cent,  albuminous 
food  as  contrasted  with  the  20  per  cent,  from  cattle  and  35 

[122] 


HYGIENE     AND     WAR 

per  cent,  from  milk  cows.  It  will  also  be  necessary  to  limit 
the  schnapps  and  beer  production.  Germany  has  up  to  now 
manufactured  16  mill.  dz.  of  barley  into  a  value  of  316  mill, 
marks  in  beer  and  27  mill.  dz.  of  potatoes  into  spirits.  Extrava- 
gance in  the  home  and  in  the  feeding  of  brutes  must  be  avoided. 
Whoever  consumes  spirits  is  destroying  the  means  of  human 
subsistence.  Less  animal  and  more  plant  food  must  be  used. 
"Each  must  set  a  good  example  if  we  would  lead  the  Gefman 
people  not  only  to  a  military  victory  but  to  a  real  true 
victory." 

The  second  lecture  of  this  session  dealt  with  'The  Signifi- 
cance of  Plant  and  Animal  Production  for  Our  Nourishment'. 
The  lecturer  dealt  with  the  effects  of  the  incoming  harvest, 
and  how  it  would  tend  to  supply  the  food  needs  of  the  people. 
One  of  the  important  phases,  he  declared,  is  the  feeding  of 
animals  and  plants  themselves.  Animal  metabolism  is  pro- 
moted by  the  employment  of  organic  substances  while  the 
plant  depends  upon  minerals.  The  lecturer  therefore  demanded 
"the  general  introduction  of  the  'tonnen-systems'  in  the 
homes  during  war  times." 

Another  lecturer  dealt  with  the  topic  'Concerning  the 
Significance  of  Fruit  and  the  Cultivation  of  Vegetables'.  He 
stated  that  Germany  has  been  importing  some  200,000,000 
marks'  worth  of  these.  By  themselves  cultivating  small 
spaces,  it  is  possible  to  help  much  in  this  respect.  Marmalades 
are  good  and  should  be  kept  in  the  home  especially  for  chil- 
dren. Material  was  then  suggested  for  an  'Anschauungs- 
kursus'. 

A  series  of  agricultural  subjects  was  also  given.  Here  are 
some  of  the  titles,  'Manuring  of  Plants  with  Special  Reference 
to  Nitrogen',  'Animal  Nourishment  and  Feeding',  'How  Must 
the  Arrangement  and  Conduct  of  Agricultural  Management 
be  Changed  in  War'? 

Special  courses  were  given  through  expert  dairy  farmers, 
millers,  slaughter-house  men,  and  through  bakeries.  All  the 
participants  were  on  one  day  taken  on  a  tour  of  inspection 
and  observation.  Explicit  precautions  to  be  taken  with  cows 


HYGIENE     AND     WAR 

used  to  supply  milk  to  children  were  shown.  Suitable  cows, 
selected  by  the  director  himself,  inspected  by  the  veterinary 
as  to  the  exact  state  of  their  health,  were  kept  in  observation 
under  quarantine  for  a  week.  They  found  extreme  cleanliness 
in  well-aired  stalls.  Feeding  of  the  stock  (cows)  is  according 
to  police  regulation  and  is  exclusively  dry  feeding.  The  milk 
of  each  cow  as  drawn  was  tested  in  the  laboratory.  Monthly 
bacteriological  tests  were  made  at  the  proper  institutes.  The 
milk  was  filtered  and  placed  in  cold  storage  (Kiihlhalle). 
Here  it  was  further  purified  and  run  through  a  ' Wattefilter' ; 
then  it  was  rapidly  cooled  and  placed  in  absolutely  pure  cans. 
This  milk  can  be  turned  out  in  'unthinkably'  pure  condition. 
The  price  per  liter  is  60  pf.;  for  pasteurized  50  pf.;  and  for 
sterilized  child's  milk  80  pf. 

In  the  third  session  a  lecture  was  given  on  'War  Bread*. 
The  following  suggestions  were  made : 

1.  Control  your  desires;  avoid  those  things  which  are  only  for  color  and 

appetite. 

2.  Buy  fat  meat. 

3.  Use  our  stock  animal  food  rationally. 

4.  Cook  a  mixed  diet. 

5.  Use  meat  properly  (hogs'  heads,  beef  lungs,  small  pieces  of  meats, 

snouts,  paws,  beef  hearts,  kidneys,  etc.). 

6.  Learn  to  refine  the  taste  of  our  time. 

7.  Store  away  only  those  things  for  which  good  space  can  be  profitably  used. 

In  a  lecture  on  'How  to  Economize'  the  following  was  put 
forth: 

1.  Economize  through  immediate  care  in  use. 

2.  Through  better  employment  of  present  grain  stock. 

3.  Through  the  consumption  of  extras  of  bread  making. 

Eat  'war  bread'  but  chew  it  well.  Those  afraid  of  their 
digestion  should  bear  this  in  mind.  Especially  in  the  evening, 
eat  cheese  and  smoked  fish  accompanied  by  sweetened  tea, 
coffee  with  honey  or  fruit  marmalade.  Use  the  'war  bread' 
preferably  for  nervous  digestion. 

Other  lectures  were  given  on  'War  Cooking',  'Reasonable 
Attitude',  'Means  and  Ways  for  the  Instruction  of  Women', 
'Retrospect  and  the  Future'. 

[124] 


HYGIENE     AND     WAR 

It  was  urged  that  the  German  people  eat  too  much;  that 
they  should  stop  eating  between  meals;  that  they  employ 
everything  from  the  kitchen  to  support  animals.  (For  example, 
one  hotel  obtained  8,000  marks  yearly  for  its  refuse.  In  one 
week  from  12,000  houses  50,000  kilograms  of  foodstuffs  were 
collected.  In  Stuttgart  it  was  found  that  there  was  a  waste 
of  8  per  cent,  in  bread  among  the  lowest  class  and  of  2.5  per 
cent,  among  the  middle  class.) 

30  per  cent,  of  the  potato  is  lost  in  peeling. 

I  kilogram  of  poorly  peeled  potatoes  gives 700  grams 

I  kilogram  of  well  peeled  potatoes  gives 740  grams 

i  kilogram  of  baked  potatoes  (with  jackets  on)  gives  .  .960  grams 

.  Skim  milk  is  cheap,  contains  much  albumen,  and  is  easily 
digested  because  it  is  without  fat.  It  is  especially  good  for 
children.  When  cooked  it  tastes  little  different  from  real 
milk. 

Another  lecturer  urged  the  women  of  Germany  to  awake. 
They  must  not  rely  on  the  lore  of  their  grandmothers.  They 
must  learn  the  true  conditions  and  how  to  meet  them.  They 
must  think  nationally,  not  individually.  The  housewife  does 
not  realize  that  the  saving  of  but  one  gram  per  day,  or  perhaps 
two  grams,  by  each  person  amounts  in  the  course  of  a  year 
among  the  whole  people  to  12,000  tons.  Two  grams  of 
bread  saved  daily  in  10,000,000  households  amounts  to 
20,000  kilograms  or  10,000  four-pound  loaves.  (More  figures 
and  illustrations  of  this  type  were  given.) 

The  Buyers'  Union  should  be  consulted  and  properly  run. 
Prices  should  be  published.  They  should  set  forth  the  best 
foods  for  the  price,  etc.  Eating  houses  should  be  controlled, 
etc.  They  should  hold  special  assemblies  for  cooks,  servants, 
waiters,  etc.  The  might  issue  receipts  for  cooking,  etc.  It 
would  be  well  to  erect  muster-kitchens  in  large  cities  in  which 
women  might  get  practical  experience.  They  should  urge  the 
stewing  of  small  pieces  of  meat.  Cook  the  small  pieces  in  a 
hot  pan  without  fat  and  roast  the  larger  pieces.  As  appetizers 
and  taste  promoters,  eggs  are  valuable.  They  serve  as  a  full 
nourishment  for  the  sick.  Their  food  value  has  been  some- 


HYGIENE     AND     WAR 

what  overestimated.  Use  bone  soup  made  by  cooking  for 
9  hours  (three  times  for  3  hours  each  to  get  lime  content  in 
proper  shape).  Use  rabbits.  These  increase  rapidly.  They 
have  been  neglected  as  a  source  of  nourishment.  Fish,  espe- 
cially dried  cod,  should  be  eaten.  Here  and  there  chickens 
must  be  used  more  than  formerly,  because  of  the  growing 
lack  of  corn.  Ground  bones,  mussel  shells,  and  practical  hen 
houses  should  be  provided.  In  the  spring  they  may  be  fed 
upon  insects — in  harvest  on  grain  and  berries.  They  should 
be  turned  loose  in  the  forest.  Germans  should  limit  the  use 
of  butter,  using  margarine  and  the  like  where  possible. 

For  fertilizers,  use  everything  available,  sweepings,  lime, 
coal  dust,  soap  water,  soot  from  the  chimneys,  sand  from 
canary  bird  cages,  dove,  chicken,  and  dog  stall  droppings, 
ashes  and  latrines  if  possible.  Beans,  lentils,  and  peas  must 
be  raised  extensively.  Use  them  green.  Dry  them  for  winter 
use.  The  fruits  and  plants  of  the  forest  are  to  be  gathered 
and  used  in  many  places,  as  also  the  unripe  fruits.  Fallen, 
plucked  berries,  through  good  sterilization  and  care  offer  a 
store  for  rich  satisfaction  in  summer.  Wise  action  will  enable 
the  wife  to  give  a  great  variety. 

Another  lecture  some  2>£  hours  long  was  given  on  'Mate- 
rials for  Dissemination  by  Wandering  Lecturers'. 

This  course  we  have  been  describing  was  given  to  those  who 
were  expected  to  do  a  species  of  University  Extension  work 
along  these  lines,  such  work  as  our  agricultural  colleges  have 
done  with  corn,  wheat,  etc. 

We  have  already  called  attention  to  the  effect  which  war 
has  on  those  at  home,  the  non-combatants — an  effect  rarely 
enumerated  and  at  this  time  not  capable  of  being  ascertained 
with  exactitude,  as  the  Commission  points  out.  Not  only  are 
there  deleterious  physical,  economic,  and  moral  effects,  but 
the  morale  of  those  at  home  is  affected.  Outrages  are  justi- 
fied by  all  parties  on  the  mere  basis  of  the  exigencies  of  war, 
war  reprisals,  vengeance,  or  necessity.  This  has  been  amply 
illustrated  in  the  present  European  conflict.  All  law  is  laid 
aside.  Each  combatant  claims  the  right  to  make  law,  not 


HYGIENE     AND     WAR 

only  with  reference  to  the  combatants  but  also  to  the  innocent 
bystanders.    The  Balkan  Commission  found 

Every  clause  in  international  law  relative  to  war  on  land  and  to  the 
treatment  of  the  wounded,  has  been  violated  by  all  the  belligerents,  includ- 
ing the  Roumanian  army,  which  was  not,  properly  speaking,  belligerent. 
(194,  p.  13) 

The  same  statement  bids  fair  to  be  true  in  the  present  war. 

As  for  the  domestic  affairs  of  the  countries  involved,  their 
energies  being  devoted  to  unproductive  labor,  there  is  a  lack 
of  balance  in  the  economic  and  industrial  world.  Refugees 
rush  from  one  part  of  the  land  to  another,  carrying  their 
wants,  their  waste  and  diseases  with  them. 

EFFECTS   UPON   MORALE  AND   MORALS 

The  N on- Combatants  in  Balkan  Wars. — To  give  a  full 
description  of  all  the  horrors  suffered  by  the  city  of  Adrianople 
and  its  environs,  as  it  passed  through  the  hands  of  the  various 
victorious  armies,  is  not  possible  here.  After  itemizing  the 
losses  of  a  family  considered  typical,  the  investigators  believe 
that 

From  the  losses  here  sustained  by  a  single  family,  father  and  two  sons, 
amounting  to  fr.  19,500  (and  the  prices  are  not  overstated,  so  we  are  assured 
by  the  inhabitants  of  Vidine),  some  idea  may  be  formed  of  the  enormous 
figures  of  the  estimated  cost  of  the  Balkan  wars  to  the  inhabitants.  The 
loss  caused  the  Servian  peasants  by  the  Bulgarian  invasions  of  Knjazevac  is 
rated  in  the  document  we  publish  at  fr.  25,000,000  or  30,000,000.  No  one, 
as  far  as  we  are  aware,  has  tried  to  estimate  the  loss  caused  the  Bulgarian 
peasants  at  Belogradthik  and  Vidine  by  the  Servian  invasion.  (194,  p.  140) 

We  have  already  mentioned  the  refugees  and  the  enforced 
emigration.  But  the  following  will  give  a  more  vivid  idea  of  the 
significance  of  the  above. 

While  the  80,000  Bulgarian  refugees  are  addressing  their  supplications  to 
Sir  Edward  Grey,  the  telegraphic  agency  at  Athens  informs  us  that  100,000 
others,  Greeks  by  nationality,  are  fleeing  from  the  Bulgarian  administra- 
tion. Exact  statistics  are  not  available,  and  we  are  aware  that  reliance  can 
not  be  placed  on  figures  given  at  popular  meetings  or  official  agencies. 
Nevertheless,  it  may  be  believed  that  we  are  not  dealing  here  with  isolated 
cases,  but  with  a  real  exodus — a  portion  of  the  picture  to  be  seen  through- 
out the  Balkans.  The  Turks  are  fleeing  before  the  Christians,  the  Bulga- 

[127] 


HYGIENE     AND     WAR 

rians  before  the  Greeks  and  the  Turks,  the  Greeks  and  Turks  before  the 
Bulgarians,  the  Albanians  before  the  Servians;  and  if  emigration  is  not  so 
general  between  the  Servians  and  the  Bulgarians,  the  reason  is  that  the 
two  nations  have  not,  so  to  speak,  encountered  on  their  own  soil,  while  that 
soil  coveted  by  each,  namely,  Macedonia,  they  regarded  as  already  peopled 
by  men  of  their  own  race.  (194,  pp.  154-155) 

The  whole  series  of  events  in  the  Balkans  serves  to  empha- 
size 

That  legitimate  national  sentiment  which  inspires  acts  of  heroism,  and 
the  perverted  and  chauvinistic  nationalism  which  leads  to  crime  are  but 
two  closely  related  states  of  the  collective  mind.  Perhaps  indeed  the  state 
of  mind  is  the  same,  its  social  value  varying  with  the  object  to  which  it  is 
directed.  We  regard  as  legitimate,  we  admire  the  deeds,  the  manifestations 
by  which  nationality  defends  its  existence.  We  speak  constantly  of  the 
'good  cause'  of  oppressed  nationalities  struggling  against  difficulties  to 
find  themselves.  But  when  these  same  nationalities  pass  from  the  defensive 
to  the  offensive,  and  instead  of  securing  their  own  existence,  begin  to  im- 
pinge on  the  existence  of  another  national  individuality,  they  are  doing 
something  illicit,  even  criminal.  In  such  a  case,  we  have  seen  the  theory  of 
state  interests  and  the  state  feeling  or  instinct  is  invoked.  But  the  state 
itself  must  learn  to  conform  to  the  principle  of  moral  freedom  of  modern 
nationalities,  as  it  has  learned  to  accept  that  of  individual  freedom.  (196, 
p.  206) 

In  closing  the  chapter  on  the  'War  and  the  Non-Combatant 
Population'  the  Commission  states: 

.  .  .  We  desire  to  remind  the  reader  that  it  presents  only  a  partial 
and  abstract  picture  of  the  war.  It  brings  together  in  a  continuous  per- 
spective the  sufferings  of  the  non-combatant  populations  of  Macedonia 
and  Thrace  at  the  hands  of  the  armies  flushed  with  victory  or  embittered 
with  defeat.  To  base  upon  it  any  moral  judgment  would  be  to  show  an 
uncritical  and  unhistorical  spirit.  An  estimate  of  the  moral  qualities  of 
the  Balkan  peoples  under  the  strain  of  war  must  also  take  account  of 
their  courage,  endurance,  and  devotion.  If  a  heightened  national  sentiment 
helps  to  explain  these  excesses,  it  also  inspired  the  bravery  that  won  victory 
and  the  steadiness  that  sustained  defeat.  The  moralist  who  seeks  to  under- 
stand the  brutality  to  which  these  pages  bear  witness,  must  reflect  that 
all  the  Balkan  races  have  grown  up  amid  Turkish  models  of  warfare.  Folk- 
songs, history,  and  oral  tradition  in  the  Balkans  uniformly  speak  of  war  as 
a  process  which  includes  rape  and  pillage,  devastation  and  massacre.  In 
Macedonia  all  this  was  not  a  distant  memory  but  a  recent  experience. 
The  new  and  modern  feature  of  these  wars  was  that  for  the  first  time  in 
Balkan  annals  an  effort,  however  imperfect,  was  made  by  some  of  the  com- 

[1281 


HYGIENE     AND     WAR 

batants  and  by  some  of  the  civil  officials  to  respect  a  European  ideal  of 
humanity.  The  only  moral  which  we  should  draw  from  these  events  is 
that  war  under  exceptional  conditions  produced  something  worse  than  its 
normal  results.  The  extreme  barbarity  of  some  episodes  was  a  local  circum- 
stance which  has  its  root  in  Balkan  history.  But  the  main  fact  is  that  war 
suspended  the  restraints  of  civil  life,  inflamed  the  passions  that  slumber  in 
times  of  peace,  destroyed  the  natural  kindliness  between  neighbors  and  set  in 
its  place  the  will  to  injure.  That  is  everywhere  the  essence  of  war.  (Italics 
author's.)  (194,  p.  108) 

The  Inadequacy  of  War  as  a  Promoter  of  Ethics. — Statistics, 
such  as  are  available,  refer  for  the  most  part  to  losses  of  the 
army  and  navy  itself  and  hence  do  but  scant  justice  to  a  total 
estimate  of  the  full  effect  upon  the  whole  population  of  a 
country.  We  have  already  pointed  out  the  inherent  difficul- 
ties in  the  way  of  obtaining  exact  data  relative  to  past  wars, 
difficulties  which  may  arise  in  the  present.  But  such  facts  as 
are  available  have  warranted  a  positive  conclusion  as  to  the 
evil  influence  of  war  upon  the  morals  and  heredity  of  the 
nations.  In  our  first  table  we  have  shown  the  losses  due  to 
some  of  the  great  wars.  But  these  do  not  reveal  the  number 
of  widows,  of  orphans,  of  cripples — an  increased  tax  upon  the 
state — nor  of  women  capable  of  mating  deprived  of  fitting 
mates.  We  have  quoted  at  length  from  the  Balkan  report 
the  facts  which  show  the  similar  disgenic  and  unmoral  effects 
of  present  wars.  We  have  presented  facts  showing  the  spread 
of  diseases  due  to  occupation  of  territory  by  infected  troops — 
diseases  of  such  a  nature  that  they  impair  the  germ  plasm 
itself,  thus  affecting  the  entire  population.  We  have  shown 
that  such  economic  and  social  adjustments  are  forced  upon 
the  people  that  it  is  impossible  during  war  times  and  for 
some  time  after  their  close  to  provide  proper  environment 
for  the  complete  development  of  the  capabilities  of  heredity. 
(See  section  on  Food.)  We  have  pointed  out  the  various  dis- 
eases which  were  already  getting  a  foothold  in  new  territories, 
largely  European.  Since  writing  that  section,  the  various 
nations  of  the  Balkans  have  become  more  largely  involved 
and  with  them  will  enter,  more  and  more,  the  diseases  men- 
tioned. 

[129] 


HYGIENE     AND     WAR 

While,  as  we  have  shown  in  several  places,  modern  war  tends 
to  confine  its  actual  results  to  the  battlefield — that  is,  more 
deaths  occur  in  actual  battle  and  fewer  from  wounds  and 
disease  owing  to  the  development  of  hygiene  in  times  of 
peace — that  fact  offers  little  comfort  when  we  scan  the  enor- 
mous fatalities  of  present  struggles. 

During  war  all  agencies  are  occupied  in  its  pursuit.  Schools 
are  often  suspended  (Balkan  report,  p.  268),  the  curriculum 
interfered  with,  medical  inspection  of  them  given  up  (see 
Introduction),  children  occupied  in  war  business,  school  plants 
even  taken  for  hospital  purposes,  municipal  sanitation,  milk 
supply,  etc.,  neglected.  This  affects  adversely  the  babes  and 
the  mothers  as  well  as  the  older  children.  There  is  no  time 
to  provide  adequate  open-air  schools,  forest  schools,  lunches, 
etc.,  even  if  there  were  means  and  people  to  operate  them. 

Baginsky  does  well  to  urge  that  the  war  theme  be  kept  out 
of  the  schools  so  far  as  possible  because  of  its  effect  upon  the 
tender  nervous  systems  of  the  young.  But  his  admonition 
can  be  of  but  little  avail  when  everything  is  war,  war  from 
morning  till  morning  again.  When  soldiers  lie  wounded,  they 
must  be  nursed,  no  matter  what  the  need  of  the  children  at 
home.  Such  is  the  condition  in  Germany  and  Servia  today. 

In  war  the  moral  ever  gives  way  to  the  expedient.  The 
present  struggle  gives  ample  evidence  of  this.  Submarine 
warfare  in  which,  to  date,  the  principal  sufferers  have  not 
been  warriors  but  innocent  non-combatants,  the  Zeppelin 
raids,  the  firing  on  unarmed  vessels  with  and  without  warning, 
the  use  of  deadly  chemicals,  all  testify  to  the  doctrine  of 
might  making  right. 

That  countless  atrocities  have  been  committed  even  in  the 
present  war,  facts  seem  to  leave  little  room  to  doubt.  Men 
cannot  see,  and  cannot  do  these  things  without  being  affected 
thereby  and  that  adversely.  While  it  might  have  been  claimed 
that  the  Balkan  wars  in  their  atrocities — rape  of  women  and 
girls,  brutal  destruction  of  children,  mutilations,  etc. — were, 
owing  to  circumstances  peculiar  to  those  peoples,  not  typical 
of  usual  wars,  the  facts  of  former  struggles  and  of  the  present 

[130] 


HYGIENE     AND     WAR 

war  furnish  almost  indisputable  evidence  to  the  contrary. 
And  it  should  be  borne  in  mind  that  the  Balkan  nations  are 
involved  now. 

The  Balkan  Commission  has  well  said,  " Widespread  and 
almost  universal  maltreatment  of  women  and  girls  by  the 
soldiers  of  the  three  nations  has  left  behind  moral  consequences 
which  cannot  be  overestimated."  (194,  p.  267)  And  again, 
"It  is  to  be  feared  that  many  a  young  man  learned  for  the 
first  time  to  commit  acts  of  violence  and  crime  not  permitted 
in  civilized  warfare."  We  might  add  that,  judging  from  the 
facts  of  the  present  war,  there  probably  is  no  such  thing  as 
'civilized  warfare'. 

Living,  breathing,  thinking  this  atmosphere  of  hate,  rapine, 
vengeance,  there  must  follow  a  psychological  reflex  whose  moral 
tone  is  conducive  to  the  lowest  standards — decidedly  immoral. 
No  one  has  ever  judged  that  the  life  of  the  soldier  in  time 
of  peace  is  conducive  to  highest  morals.  Only  where  he  has 
sufficient  work  to  keep  him  busy  is  it  possible  for  him  to  control 
the  human  passion.  A  large  standing  army,  except  in  time 
of  war,  is  necessarily  idle  much  of  the  time.  The  result  of  this 
is  the  same  whether  in  soldier  or  in  civilian — a  letting  down  of 
the  inhibition  necessary  to  the  best  interests  of  society.  A 
community  is  inclined  to  suffer  morally  from  the  presence  of 
idle  troops  no  matter  how  fine  a  body  of  men  these  may  have 
been  in  their  private  lives,  outside  of  the  army. 


V.    THE  ELIMINATION  OF  THE  MOST  FIT 

RECRUITS 

Type  of  Men  Selected. — In  ancient  times,  it  was  thought  that 
any  man  was  fit  material  for  a  soldier,  regardless  of  age, 
condition,  or  physical  fitness.  An  opinion  quite  current  is 
that  young  men  make  the  best  soldiers.  It  is  also  held  by 
many  that  the  well-built,  well-muscled  man  makes  a  good 
soldier.  The  first  idea  has  been  utterly  discarded,  the  second 
has  proved  untrue,  and  the  third  is  true  only  under  certain 
limitations.  "A  soldier  is  a  machine  of  two  parts,  legs  and- 
arms  offensive,  chest  and  abdomen  vital."  It  is,  therefore, 
essential  that  he  be  fit  physically  and  psychologically.  (259, 
260) 

Regular  army  men  of  the  old  school,  men  who  did  not 
comprehend  the  importance  of  the  medical  corps  or  of  psychi- 
cal factors,  erred  in  their  evaluation  of  the  soldiers  of  the 
regular  army  and  of  the  volunteers.  They  failed  to  realize 
that  the  quality  of  the  recruit  varies  inversely  as  the  condi- 
tions of  labor  at  the  time  of  his  enlistment.  They  did  not  give 
sufficient  value  to  the  influence  of  ideals  in  the  training  and 
conduct  of  the  two  types.  They  failed  to  remember  that  as 
a  rule  the  volunteer  represents  a  far  more  ambitious,  energetic, 
and  resourceful  man  than  the  regular  army  man. 

The  facts  show  that  a  most  careful  selection  must  be  made. 
Each  recruit  costs  Great  Britain  about  $486  for  the  first  three 
months.  Should  he  prove  unfit,  this  means  loss  of  money, 
time,  and  energy.  For  this  selection,  there  is  need  of  special 
trained  officers.  In  the  United  States  the  recruiting  officer 
selects  one  out  of  every  three  or  four  applicants.  Those 
selected  are  then  passed  upon  by  the  medical  examiner.  In 
England  the  recruiting  officer  has  been  passing  upon  the 
physical  characteristics  of  the  volunteer  and  the  combatant- 
officer  has  had  to  take  care  of  the  psychical  condition  of  the 

[132] 


HYGIENE     AND     WAR 

men.  Sir  Thomas  Oliver  states  that  poor  medical  examina- 
tion of  recruits  has  already  cost  the  country  £2,000,000. 
(165,  400) 

He  also  points  out  that  modern  warfare  has  so  changed 
conditions,  that  it  is  unnecessary  for  all  the  men  to  have 
perfect  vision,  perfect  physique.  Sappers,  trench-diggers,  etc., 
are  quite  as  essential  to  the  success  of  the  army  as  men  who 
can  see  to  shoot,  etc. 

It  is  reported  that  the  general  physique  of  the  volunteers 
in  England  and  her  colonies  is  quite  high.  (246,  399) 

That  there  would  be  errors  in  the  acceptance  of  recruits 
at  such  a  time  of  stress  is  to  be  expected.  Especially  when 
one  considers  that  from  a  normal  annual  enlistment  of  35,000 
the  number  mounted  to  between  250,000  and  300,000  for  one 
month  in  England  alone. 

In  the  light  of  such  facts  as  pointed  out  by  Sir  Oliver,  the 
War  Department  of  Great  Britain  has  seen  fit  to  make  the 
requirements  for  enlistment  less  stringent  than  at  the  outset 
of  the  war.  (401). 

In  the  selection  of  men,  it  is  well  to  consider  their  previous 
training.  One  author  points  out  that  for  immediate  service, 
city-bred  volunteers  may  prove  more  efficient  than  country 
bred,  though  in  case  of  prolonged  struggle,  the  latter  will 
prove  superior.  This  he  thinks  due  to  the  fact  that  the  open 
air,  regular  meals,  routine,  sleep,  etc.,  of  camp  act  as  a  tonic 
for  the  irregular  city  man.  The  country  man  is  already  used 
to  such  habits  but  not  having  been  exposed  to  the  infections 
of  city  life  is  liable  to  suffer  severely  from  infectious  diseases 
and  the  monotony  of  camp  life.  (116,  133,  259) 

Also  the  previous  employment  of  the  men  should  be  con- 
sidered. Men  who  have  engaged  in  very  laborious  work  age 
more  rapidly,  their  muscles  become  firmly  set  earlier  and 
hence  they  lack  adaptability.  Thirty  per  cent,  of  the  rejections 
at  Tyneside,  England,  were  for  this  reason.  On  the  other  hand, 
such  men  are  inclined  to  be  steady  and  to  act  as  a  fine  balanc- 
ing force  upon  the  younger  men  of  the  company.  For  such 
reason,  clerks,  teachers,  and  those  engaged  in  similar  occupa- 

[133] 


HYGIENE     AND      WAR 

tions  may  be  accepted  at  an  older  age  than  miners,  section 
men,  etc.  (165,  399) 

Sir  Oliver  points  out  that  the  previous  occupation  of  the 
men  may  even  prove  a  positive  factor  for  good  in  their  army 
work.  Miners  make  superior  trench-diggers — carpenters, 
joiners,  builders  excel  in  preparing  grounds  for  camps  and 
buildings,  etc.  He  shows  that  military  training  finds  the 
weak  spot  of  the  body.  For  example,  the  knees  of  the  miner 
are  stiff  from  his  constant  bending,  and  after  some  time  in  the 
service  he  is  apt  to  develop  nystagmus  and  be  most  effective 
in  seeing  in  twilight  vision.  Among  those  enlisting  from  the 
Northumberland  district,  albuminuria  was  found  in  a  small 
per  cent,  of  apparently  healthy  recruits  after  hard  work.  They 
found  not  over  from  I  to  2  per  cent,  of  venereal  disease  among 
those  from  Tyneside.  The  amount  of  crime  was  small.  While 
typhoid  vaccination  was  voluntary,  there  was  no  trouble  in 
getting  the  men  to  submit  to  it. 

The  principal  defects  found  among  men  who  apply  for 
enlistment  in  the  armies  of  the  various  nations  are,  venereal 
diseases,  heart  abnormalities,  defective  vision  or  hearing,  foot 
deformities,  and  poor  physique.  While  the  recruiting  officer 
cannot  get  at  the  internal  diseases  easily,  he  can  pick  out 
the  following:  deformities,  inebriety,  flat  foot,  piles,  skin 
eruptions,  lice,  stiff  joints,  varicose  veins,  pallor,  rupture, 
dirty,  indecent  tattooing,  emaciation,  defective  development  of 
parts,  etc.  (116,  ch.  II.) 

Age. — In  1798,  the  68th  Bombay  Regiment,  composed 
chiefly  of  boys,  lost  nearly  half  its  number  from  sickness  and 
could  not  be  transported,  while  the  6ist  Regiment,  composed 
of  900  old  soldiers,  was  on  board  ship  for  16  weeks  and  landed 
with  but  one  man  sick. 

In  the  Peninsular  War,  300  five-year  men  (1805-1814)  were 
considered  superior  to  1,000  lad  recruits.  (259,  ch.  I.) 

Officers  in  the  Mexican  War  report  that  the  young  men 
suffered  most. 

Lord  Raglan  found  that  young  recruits  were  unable  to 
stand  the  campaigns  of  the  Crimean  War.  General  Roberts 

[134] 


HYGIENE     AND     WAR 

likewise  found  that  his  youth  succumbed  in  the  march  from 
Cabul  to  Candahar.  The  surgeon-general's  report  of  1885 
shows  that  up  to  the  age  of  25,  the  rate  of  sickness  in  peace 
times  proved  very  much  above  the  mean  for  the  whole  army. 
The  most  effective  armies  have  been  those  whose  age  was  not 
less  than  22  years.  Physical  maturity  is  reached  between 
23  and  25  years.  (259,  260) 

Woodhull  states  that  the  epiphyseal  plates,  especially  of 
the  sacrum  do  not  reach  their  complete  development  till  about 
the  26th  to  the  3Oth  year.  As  the  bones  of  the  back  are  not 
mature  and  as  it  is  the  'hollow  of  the  back'  which  receives 
strain,  it  is  here  that  fatigue  is  liable  to  be  most  felt.  Since 
the  sacrum  and  hip  bones  form  the  means  of  support  for  the 
weight  of  the  soldier,  they  need  to  be  fully  developed. 

Likewise  any  pressure  placed  upon  the  undeveloped  chest, 
is  liable  to  cause  serious  displacement  of  lungs  and  heart. 
Such  pressure  is  exerted  by  the  equipment  that  the  soldier 
must  carry.  The  postures  which  he  must  assume  are  also 
liable  to  interfere  with  normal  development.  It  is  during 
pubertal  years  that  the  heart  increases  most  in  size.  The 
relative  capacity  of  the  sides  of  the  heart  changes,  the  ratio 
at  birth  being  right  side  to  left  as  I  :  iJ/2 — at  the  age  of  30, 
as  3  :  i. 

So  far  as  possible  the  individual  and  not  iron-clad  rules 
should  be  considered  in  enlisting.  Factors  we  have  previously 
mentioned  should  also  be  considered.  The  first  call  for  100,- 
ooo  volunteers  in  Great  Britain  gave  the  age  requirements, 
for  privates,  19  to  30  years,  and  for  ex-soldiers  42  years.  The 
next  call  gave  the  age  requirements  for  privates  19  to  35, 
and  for  non-commissioned  officers  up  to  45  years.  (399) 

In  the  United  States,  the  minimum  age  for  enlistment  is 
1 6  for  musicians,  18  for  all  other  branches  of  the  service. 
The  maximum  age  for  cavalry  is  30  years ;  for  all  other  branches 
it  is  35-  (359,  260) 

Height,  Weight,  Chest  Measurement,  Deformities. — As  more 
or  less  typical  of  the  requirements  of  most  armies,  those  of 
the  United  States  may  be  given.  The  minimum  height  for 

[135] 


HYGIENE     AND     WAR 

all  branches  of  the  service  is  five  feet  four  inches.  The  maxi- 
mum height  for  cavalry  is  five  feet  ten.  The  maximum  weight 
for  cavalry  is  165  pounds  and  for  other  branches  190  pounds; 
the  minimum  is  128  pounds.  Two  general  rules  may  be 
followed  in  regard  to  weight :  I.  Multiply  the  height  expressed 
in  inches  by  two;  multiply  the  difference  between  five  feet 
seven  inches  and  the  recruit's  height  by  two;  add  these  prod- 
ucts for  the  weight;  or  2.  The  average  weight  should  be  two 
pounds  to  the  inch  up  to  five  feet  seven  inches;  add  seven 
pounds  for  each  inch  in  excess  of  this. 

Chest  capacity  is  determined  by  measurement  and  chest 
mobility.  The  measurements  are  taken  at  forced  inspiration 
and  expiration,  the  latter  being  the  more  important.  Mobility 
is  the  difference  between  the  extremes.  The  nipple  circum- 
ference should  be  about  one-half  the  height.  A  man  of  five 
feet  six  inches  should  inspire  from  174  to  262  inches.  A  barrel- 
shaped  chest  is  the  best.  Persons  from  five  feet  four  to  five 
feet  seven  inches  should  measure  thirty-four  inches  and  have 
a  minimum  mobility  of  two  inches  and  a  minimum  expiration 
measurement  of  thirty-two  inches.  For  those  above  five  feet 
seven  inches,  the  mobility  should  be  2>^  inches  and  %  inch 
should  be  added  for  every  inch  above  that  height. 

Minor  deformities  which  do  not  interfere  with  proper  organic 
functioning  may  be  ignored.  But  any  defect  which  is  at  all 
liable  to  impair  the  efficiency  of  the  soldier  must  be  seriously 
considered. 

To  some  these  requirements  may  seem  most  arbitrary  but 
they  are  not — being  based  on  the  actual  requirements  for  the 
mechanics  of  war.  It  must  be  remembered  that  the  soldier 
marches  and  carries  his  equipment.  This  requires  a  regular 
uniform  stride  and  sufficient  strength  to  carry  the  load 
imposed.  As  the  average  stride  is  about  six-sevenths  the 
length  of  the  leg,  it  is  necessary  to  have  all  the  men  approxi- 
mately the  same  height  since  they  must  proceed  together. 
Furthermore,  as  they  profit  much  by  the  use  of  rhythm  in 
marching,  there  is  all  the  more  need  for  uniformity  of  pace. 
A  march  of  15  miles  up  and  down  hills,  carrying  an  equipment 

[136] 


HYGIENE     AND     WAR 

of  fifty  pounds,  means  the  performance  of  350  foot  tons  of 
work.  To  do  this,  requires  a  certain  minimum  weight  in  the 
soldier. 

Our  ordinary  army  pace  is  thirty  inches  at  the  rate  of  90 
per  minute;  quick  time  is  120  per  minute  and  gives  about 
3  2-5  miles  per  hour;  double  time  is  1 80  thirty-five-inch  paces 
per  minute  and  gives  about  6  miles  per  hour.  It  is  used  in 
rushes  and  is  very  exhaustive.  Twenty  minutes  of  such  prac- 
tice is  enough.  The  German  step  is  thirty- two  inches  at  the 
rate  of  114  per  minute  and  gives  about  3.5  miles  per  hour. 
Their  attack  rate  is  120.  This  step  seems  too  long.  The 
English  quick  time  rate  is  the  same  as  ours.  Their  double 
time  is  a  33-inch  pace  at  the  rate  of  175  to  the  minute.  From 
these  numbers,  it  will  be  seen  that  height  and  weight  are 
important  items.  (43) 

When  the  chest  is  considered  as  the  receptacle  of  the  lungs 
and  heart,  the  significance  of  its  being  well  developed  is 
easily  understood.  The  lungs  not  only  supply  the  air  which 
oxygenates  the  blood,  purifying  it  and  also  liberating  heat 
through  oxidation,  but  this  same  air  also  helps  to  maintain 
the  normal  temperature  of  the  body,  especially  during  periods 
of  marching,  etc.,  by  helping  to  prevent  the  raising  of  the 
normal  temperature  to  the  danger  point. 

General  Health. — The  recruiting  officer  should  examine  the 
pulse.  If  it  drops  a  beat  the  applicant  should  be  rejected. 
Likewise  the  eyes  and  ears  should  be  tested.  As  we  have 
before  mentioned,  one  should  note  the  nature  of  the  defect 
and  consider  it  carefully  before  rejecting  the  recruit,  who, 
though  he  may  not  be  able  to  be  a  sharpshooter,  may  make 
an  excellent  trench-man,  cook,  etc.  In  general,  the  soldier 
should  be  able  to  hear  ordinary  conversation  at  a  distance  of 
fifty  feet.  Arterio-sclerosis  and  rheumatism  justify  rejection. 
(400) 

"A  tolerably  just  proportion  between  the  different  parts 
of  the  trunk  and  members,  a  well-shaped  head,  thick  hair, 
countenance  expressive  of  health,  with  lively  eye,  skin  not 
too  white,  lips  red,  teeth  white  and  in  good  condition,  voice 

[137] 


HYGIENE     AND     WA  R 

strong,  skin  firm,  chest  well  formed,  belly  lank,  organs  of 
generation  well  developed,  limbs  muscular,  feet  arched  and 
of  moderate  length,  hands  large,"  are  characteristics  of  a 
good  soldier.  (259,  260) 

Men  likely  to  be  intemperate  should  be  rejected  as  should 
those  with  flatfootedness.  Recent  inflamed  large  bunions 
should  cause  rejection.  The  head  should  be  examined  for 
abnormalities.  The  soldier  should  have  at  least  intelligence 
sufficient  to  understand  the  modern  weapons.  The  thumb 
and  forefinger  of  the  trigger  hand  should  be  sound.  Hernia 
should  cause  rejection.  The  testicles  should  be  handled  and 
if  sensitive  or  dwindled,  the  man  should  be  rejected. 

Rejection  should  also  follow  the  finding  of  enlarged  veins  of 
ankle,  behind  the  knee  or  on  the  thigh.  Observe  how  nearly 
symmetrical  is  the  action  of  applicant  as  well  as  his  per- 
spiration. 

Habits. — So  far  as  possible  careful  inquiry  should  be  made 
into  the  habits  of  the  recruit.  If  they  are  of  the  drug  type, 
in  general  it  is  best  to  reject.  Owing  to  the  stress  of  war,  in 
parts  of  France  the  drug  supply  has  been  so  diminished  that 
some  have  been  forced  into  abstinence.  In  some  cases  this 
seems  to  have  done  them  good  and  helped  them  break  the 
habit.  However,  the  lack  of  their  toddy,  opium,  etc.,  may  in 
some  cases,  render  them  unfit  for  service,  and  make  them  a 
tax  on  the  already  burdened  medical  corps.  Of  tobacco  and 
alcohol  we  shall  have  more  to  say  later.  (376) 

These  facts  show  that  all  these  conditions  and  requirements  of 
a  good  recruit  and  good  soldier  are  the  product  of  peace  and  are 
such  as  many  of  our  businesses  and  occupations  demand.  The 
study  of  efficiency  has  shown  how  necessary  it  is  that  these  same 
elements  be  considered  in  the  selection  of  workmen  and  in  their 
work. 

Teeth — Importance. — All  those  reasons  which  exist  for  the 
proper  care  of  the  teeth  among  civilians,  hold  for  the  soldier 
and  this  in  addition:  that,  since  the  food  which  he  eats  is 
limited  in  variety  and  is  generally  of  a  hard  texture,  sound 
teeth  are  absolutely  necessary  for  good  digestion  and  health. 


HYGIENE     AND     WAR 

One  writer  (412)  claims  the  English  have  the  worst  teeth, 
the  Arabs  the  best.  He  states  that  the  Moroccans  and  Alge- 
rians have  almost  perfect  teeth.  He  finds  that  the  English 
and  French  soldiers  are  troubled  with  inflamed  gums.  So 
vital  are  good  teeth  to  health  that  dental  aid  is  being  rendered 
to  the  English  troops.  All  expenses  necessary  to  render  the 
men  fit  are  met  by  the  war  office.  The  limit  of  £i  per  man 
may  be  exceeded  up  to  £3  when  necessary  (410).  It  is  stated 
that  during  the  Boer  War  (411)  2,500  were  invalided  home  on 
account  of  the  teeth.  This  was  a  loss  of  about  one-fourth 
million  pounds  sterling  to  the  nation.  Dr.  F.  Newland-Pedley 
says  the  arrival  of  dental  officers  in  the  British  army  was 
needed  and  welcome.  He,  as  a  military  man,  urges  the  inspec- 
tion and  treatment  of  children's  teeth  from  the  time  they  are 
cut.  He  would  have  neglect  punished  by  law.  The  dentist 
in  the  field  should  be  prepared  to  treat  caries  and  exposed 
pulp — to  save  as  well  as  extract  teeth.  He  points  out  that 
unlike  the  Japs  in  their  war  with  Russia,  the  British  troops 
in  their  retreat  towards  Paris  left  their  toothbrushes— did 
not  take  care  of  their  teeth.  It  might  be  well  to  give  extra 
pay  for  good  teeth  and  their  proper  care.  He  suggests  that 
perhaps  cutting  the  allowance  of  soldiers,  their  wives  and 
children  in  times  of  peace  if  they  neglect  the  care  of  their  teeth 
might  prove  beneficial. 

In  the  use  of  antiseptic  powder,  it  should  be  allowed  to 
stay  in  contact  with  the  gums  and  teeth  for  some  time  if  it 
is  to  be  at  all  efficacious.  The  dental  corps  should  make  as 
frequent  examinations  as  conditions  will  permit  and  the 
soldier  in  caring  for  his  teeth  should  observe  all  the  details 
used  at  home  in  the  civilian  state.  (179) 

Clothing. — The  results  of  military  men's  study  of  clothing 
may  be  observed  with  profit  by  all.  The  purpose  of  clothing 
is  to  protect  from  cold,  heat,  snow,  sleet,  rain,  bruises,  dirt, 
and  diseases.  It  should  be  suited  to  the  region,  race,  and 
purpose  for  which  it  is  to  be  employed  and  of  such  texture 
as  to  be  comfortable.  Adornment  is  to  be  considered  only 
in  times  of  peace.  It  must  be  inconspicuous  in  color  and 

[139] 


HYGIENE     AND     WAR 

style  and  suitable  for  service.  It  should  be  of  good  quality, 
durable,  of  moderate  cost  and  permeable  to  air.  It  should 
conduct  and  radiate  heat  properly.  Its  weight  will  vary  with 
climate  from  6^2  to  nX  pounds.  (116,  chs.  Ill,  VI,  VII; 
259,  ch.  II;  133,  ch.  I.) 

The  hat  should  be  light  in  weight  with  abundance  of  air 
space  in  the  crown.  The  campaign  hat  with  crown  peaked 
is  best  suited  for  the  field.  It  was  found  with  an  open  air 
temperature  of  90.2  deg.  Fahr.,  the  temperature  in  the  crown 
of  an  old  pattern  forage  cap  was  100.5  deg.  Fahr. ;  in  the  black 
felt  hat  it  was  98.3  deg.  Fahr.;  in  ordinary  straw,  95  deg. 
Fahr.;  and  in  cadet  helmet  92.5  deg.  Fahr.  (259,  ch.  II.) 
Black  is  the  warmest  and  white  the  coolest  color.  Red  is  one 
of  the  most  conspicuous  colors  and  draws  the  fire  of  the  enemy ; 
white  next,  followed  in  order  by  black  or  dark  blue,  light 
blue,  butternut,  and  dust  gray. 

Material  for  Clothes. — Among  the  materials  suggested  for 
clothing  are  cotton,  linen,  paper,  and  wool.  Leather  cloth 
and  oiled  cloth  have  also  been  tried.  Cotton  and  linen  are 
conductors  of  heat.  "A  thin  white  cotton  tissue  worn  over 
a  cloth  coat  will  reduce  the  temperature  of  the  sun's  rays  2.6 
deg.  Fahr."  (259,  ch.  I.)  Wool  has  proved  most  satisfactory 
under  all  conditions.  It  is  practically  a  non-conductor  of  heat 
and  absorbs  moisture.  It  tends  to  harden  with  washing, 
hence  care  should  be  exercised  in  this.  Though  dark  colors 
tend  to  retain  odor,  they  are  warmest.  The  Japanese  in  their 
Manchurian  campaign  used  paper  vests. 

The  articles  forming  the  soldiers'  clothing  outfit  consist  in 
general  of  hat,  underclothes,  socks,  shirt,  coat,  leggings  or 
puttees,  belt,  trousers  or  if  pressure  from  bending  at  the  knees 
can  be  prevented,  breeches  instead,  storm  coat  or  poncho, 
pack  and  general  equipment,  and  shoes.  It  has  been  found 
that  it  is  better  to  use  a  belt  instead  of  suspenders.  There  is 
a  tendency  to  have  both  leggings  and  puttees  too  tight,  which 
prevents  free  circulation,  thus  aiding  in  development  of 
'frost-bitten  feet',  etc.  For  this  reason  one  author  suggests 
that  a  heavy  woolen  stocking  pulled  up  the  leg  over  the  shoe 

[140] 


HYGIENE     AND     WAR 

will  fulfill  the  purpose  of  the  former  with  greatest  satisfaction. 
From  reasons  suggested  above,  it  is  best  to  have  the  under- 
clothing of  some  light  color.  It  should  be  changed  daily, 
and  washed  as  often  if  possible.  Where  garters  are  used,  care 
must  be  exercised  that  they  do  not  impede  the  circulation. 
In  cold  seasons  gloves  are  provided.  The  Mackinaw  coat 
has  proved  more  satisfactory  than  the  overcoat.  Khaki  seems 
to  have  demonstrated  its  superiority  as  a  material.  In  general, 
military  attire  must  be  inconspicuous  in  color,  of  good  dura- 
bility, quality,  moderate  cost,  distinctiveness,  and  permea- 
bility to  air,  as  well  as  have  proper  qualities  of  heat  conduction 
and  radiation. 

Methods  of  Water-proofing. — In  some  cases  the  clothing  is 
water-proofed  by  coating  the  outer  garments  with  rubber. 
The  same  is  also  accomplished  by  varnishing  and  oiling  them. 
They  may  be  made  water-proof  by  impregnating  them  with 
lanolin  in  benzine  or  with  aluminum  acetate.  (116) 

One  of  the  chief  objects  of  clothing  is  to  maintain  normal 
body  temperature.  Experiments  in  India  have  proved  that 
a  layer  of  blood  1-500  inch  thick  is  impermeable  to  most 
powerful  sunlight  (actinic  rays).  This  was  confirmed  by  tests 
in  Manila  in  which  men  were  clad  in  underclothing  of  red  and 
white  respectively  and  observed  as  to  sickness  and  weight  for 
a  year.  Those  clad  in  red  suffered  most.  The  blood  in  the 
capillaries  is  sufficient  protection.  (133) 

Clothes  should  not  constrict  at  any  point. 

Shoe. — The  shoe  is  one  of  the  most  important  parts  of  the 
soldier's  equipment. 

The  following  are  some  of  the  conditions  it  should  fulfill : 

1.  It  should  be  of  good  material  and  well  made,  having  strength  without 

undue  weight. 

2.  It  should  be  fairly  pliable  with  flexible  uppers  (porous). 

3.  There  should  be  no  'canoeing'  of  sole- welts  which  should  be  moder- 

ately wide. 

4.  The  interior  should  be  smooth,  heel  broad  and  low,  sole  moderately  thick. 

5.  The  arch  should  be  flexible  without  metal  shank  or  other  stiffening. 

6.  It  should  have  eyelets,  not  hooks,  for  fastening,  the  tongue  should  lie 

smooth  under  lace. 

[HI] 


HYGIENE     AND     WAR 

7.  Shoe  should  reach  a  little  above  the  ankle,  should  be  wide  across  the 

ball  of  the  foot  and  have  a  high  toe  cap. 

8.  It  should  be  easily  put  off  and  on. 

9.  It  should  have  water-proof  stitching  of  joints  and  seams  with  the  sewing 

of  tongue  at  least  two  inches  up  the  sides  of  uppers. 

10.  It  should  have  easy  flexion  of  sole  across  line  of  tread  with  rigidity  at 

waist. 

11.  The  curvature  of  instep  and  heel  should  be  natural. 

12.  It  should  be  of  proper  size.    The  shoe  should  be  tried  on  at  the  close 

of  the  day  when  the  foot  is  swollen  and  hot ;  should  be  laced  up  com- 
pletely. They  should  be  broken  in  gradually.  If  it  is  necessary  to 
use  them  at  once  it  is  a  good  plan  to  stand  them  in  water  till  they 
are  sodden.  Then  put  them  on  and  walk  in  them  on  level  ground 
for  about  one  hour.  Let  them  dry  on  the  feet.  Upon  removal 
rub  them  thoroughly  with  neat's  foot  oil.  Too  much  care  can- 
not be  exercised  in  the  selection  of  shoes.  A  size  large  is  generally 
best. 

Washing  Clothes. — Lelean  urges  the  soldiers  to  change  the 
clothing  daily  where  possible.  He  suggests  that  underclothes 
be  washed  at  least  once  per  week  and  points  out  that  the 
laundry  water  becomes  bacterially  infected  very  rapidly. 
Hence  a  steady  flow  of  the  water  used  is  desirable  or  steriliza- 
tion by  chlorination.  The  blankets  should  be  dipped  in  boil- 
ing water,  then  washed  at  once  in  warm  water  and  dried  with- 
out wringing.  This  will  tend  to  prevent  shrinkage  and  will 
kill  the  bacteria.  Clothing  should  not  be  dried  in  the  men's 
quarters.  Another  author  suggests  that  wool  be  washed  in 
cold  water  to  prevent  shrinkage.  If  water  is  not  available 
at  the  end  of  the  march  or  day,  dry  the  clothes  and  then  rub 
or  beat  them  afterwards,  hanging  them  in  the  open  air.  Dirty 
clothes,  especially  underclothes,  increase  friction,  chafe,  and 
thus  put  an  extra  tax  on  the  body. 

Equipment. — The  equipment  should  not  exceed  from  40  to 
50  pounds  or  about  30  per  cent,  of  one's  own  weight.  The 
web  sling  has  proven  the  most  convenient  way  of  carrying. 
Avoid  chest  constriction;  distribute  the  weight  as  evenly  as 
possible.  The  pack  should  be  made  so  that  the  entire  load 
can  be  thrown  off  with  one  movement.  The  forms  of  pack 
are  various — different  nations  preferring  different  styles.  Con- 


HYGIENE     AND     WAR 

venience  in  carrying  is  the  chief  factor  to  be  considered.  The 
load  should  be  carried  not  too  high  so  as  to  interfere  with 
erect  posture.  It  should  be  carried  well  down  the  back  and 
should  tend  to  fall  away  from  the  body — not  being  in  contact 
with  it.  The  pack  should  be  transported  wherever  possible 
in  order  to  conserve  the  soldier's  strength. 

In  times  of  rush,  such  as  in  the  present  war,  care  should 
be  exercised  by  the  government  in  the  purchase  of  clothes ;  for 
there  is  the  possibility  of  their  being  made  under  sweatshop 
conditions  in  most  unhygienic  surroundings.  Here  they  may 
be  infected  and  become  disease-carriers.  (274,  275) 

EUGENICS  AND  WAR 

From  those  who  claim  that  war  takes  away  the  best  to  those 
who  claim  that  it  provides  for  their  survival  is  certainly  a 
wide  range.  And  the  data  are  conspicuous  by  their  absence. 
In  view  of  the  fact  that  we  cannot  have  data  as  to  the  accom- 
plishments of  the  non-survivors  had  they  survived,  our  con- 
clusions must  be  inferential  at  the  best.  If  the  canons  of 
selection  used  in  recruiting  are  fulfilled,  it  would  seem  self- 
evident  that  many  of  the  best,  judged  by  every  eugenic 
standard  known,  do  perish,  do  not  survive,  do  not  propa- 
gate their  kind.  Yet  in  spite  of  wars  the  population  has 
increased,  even  in  war-ridden  countries. 

It  is  difficult  to  believe  that  the  taking  of  so  many  young 
men  and  those  in  the  prime  of  life  from  their  homes,  as  hap- 
pened in  our  Civil  War,  affects  the  country  favorably  in 
promoting  the  survival  of  the  fittest.  Though  it  is  impossible 
to  measure  the  effect  by  any  standard  known  it  would  seem 
that  the  destruction  of  a  large  part  of  the  productive  force 
of  the  land  must  deter  progress,  must  at  least  result  in  a  sort 
of  plateau  on  which  the  nation  rests  until  it  has  recuperated 
and  gathered  momentum. 

We  know  of  no  sufficient  data  either  to  substantiate  or 
refute  this  assertion.  In  fact,  as  suggested  in  our  introduc- 
tion, machinery  for  the  gathering  of  data  has  been  absent. 


HYGIENE     AND     WAR 

War  a  Home  Maker. — In  an  article  entitled,  'War  as  a 
Home  Maker',  Dr.  Howard  says:  "War  is  one  of  the  rhyth- 
mic conditions  in  man's  progress."  He  thinks  it  brings  out 
all  the  maleness  in  man  and  femaleness  in  woman.  It  is  a 
powerful  sex-establisher.  It  forces  woman  to  her  true  sphere 
— the  home  and  hearth  and  the  bearing  of  children.  Hence 
it  is  really  a  home-maker  as  well  as  breaker.  (99) 

He  suggests  that  when  the  energy  of  the  suffragette  is 
turned  to  taking  care  of  the  wounded,  etc.,  glands  will  func- 
tion which  will  cause  a  proper  balance  in  her  whole  being 
and  make  for  normal  sex  life,  and  the  desire  to  be  mannish 
will  disappear.  The  suppression  of  her  emotions  during  the 
last  forty  years  has  caused  her  to  turn  to  things  other  than 
those  for  which  she  is  best  suited  and  has  developed  hysteria 
and  neurasthenia,  etc.  War  gives  scope  to  the  maternal 
instinct,  hence  is  beneficial.  "Rampant  feminism  is  not 
founded  upon  femaleness;  it  is  a  negative  state — a  form  of 
psychic  eunuchism."  These  emotions  merge  after  the  war 
into  desire  for  children.  This  he  claims  accounts  for  the 
increased  birth  rate  after  a  war.  War  follows  a  period  of 
effeminization  of  men  and  masculinization  of  women. 

That  Dr.  Howard  is  a  true  son  of  Adam  may  be  seen  from 
the  following:  "Indirectly  and  subjectively  through  the 
decline  of  male  sex-honor,  women  have  been  the  cause  of 
wars."  '  .  wars  make  a  strong  man  out  of  the  weak- 

ling." He  fails  to  state  how  this  is  established  in  the  germ 
plasm.  Those  too  weak  to  enlist  will  not  be  able  to  mate, 
for,  says  Dr.  Howard,  they  will  have  no  attraction  for  the 
normal  girl. 

With  some  of  his  concluding  ideas  we  are  more  in  accord. 
"The  present  colossal  war  will  be  the  greatest  school  for 
personal  hygiene  the  world  has  ever  known  since  Moses 
kept  his  men  and  women  clean  through  laws  you  should  read 
and  understand."  He  rightly  points  out  that  the  discipline 
of  the  army,  contact  with  nurses,  and  such  vents  as  war 
offers  for  correct  impulses,  will  send  home  survivors  fit  to 
marry,  who  will  marry  because  of  desire  for  true  home 

[144] 


HYGIENE     AND     WAR 

relations.  And  he  thinks  the  women  will  be  anxious  to 
marry  them. 

Need  of  Providing  for  Future. — Chambers  asserts  that 
the  view  is  held  by  some  that  from  a  eugenic  point  of  view 
war  is  beneficial,  that  the  physical  standards  set  and  the  habits 
of  orderliness  formed  will  tend  to  make  the  men  better.  Grant- 
ing this  to  be  true,  it  yet  remains  to  be  shown  how  this  will 
effect  a  change  in  the  germ  plasm.  It  is  pointed  out  by  those 
who  claim  that  the  best  are  not  lost,  that  the  Scotch,  the 
Zulus,  the  survivors  of  the  Wars  of  the  Roses,  of  the  wars  of 
Frederick  the  Great,  were  the  best.  On  what  evidence  we 
are  not  told.  To  offset  some  of  the  evils,  Chambers  suggests 
that  the  marriage  of  those  going  to  the  front  be  encouraged. 
The  state  should  provide  for  the  families  of  those  enlisted. 
He  states  that  the  professional  class  of  workers  will  suffer 
most  from  non-employment  as  their  services  will  be  less 
necessary,  while  the  industrial  classes  will  probably  be  kept 
employed.  That  large  class  who  furnish  the  leisure- time 
amusements  of  the  people  will  have  nothing  to  do,  and  the 
women,  unable  to  take  up  other  things,  will  suffer  much.  The 
results  of  this  non-employment  will  be  disgenic  and  the 
number  of  births  will  decrease.  (34) 

An  anonymous  writer  says  that  in  a  voluntary  army  such 
as  that  of  Great  Britain  the  cream  of  the  population  certainly 
suffers.  These  are  suggested  as  possible  means  of  alleviating 
this  to  some  extent:  (326) 

1.  By  increasing  the  birth  rate  of  the  depleted  class  and  by  taking  every 
precaution  that  the  greatest  possible  percentage  of  births  of  this  class  reach 
maturity. 

2.  With  these  objects  in  view,  all  who  wish  to  marry  before  leaving  the 
country  should  be  encouraged  to  do  so — the  fullest  security  being  given  that 
every  wife  shall  be  well  cared  for  and  properly  looked  after  in  the  husband's 
absence. 

3.  The  wives  and  children  of  those  who  have  gone  to  the  front  should  be 
well  cared  for  and  encouraged  to  maintain  the  advantage  already  gained  in 
the  struggle  for  existence. 

4.  Every  possible  means  should  be  taken  to  prevent  the  economic  dis- 
turbances caused  by  the  war  proving  disastrous  to  those  who,  by  reason  of 
age  or  other  causes,  have  been  unable  to  go  on  active  service. 

[145] 


HYGIENE     AND     WAR 

Disgenic  Effects. — Thomson  gives  the  following  disgenic 
tendencies  of  modern  war:  (233,  234,  235) 

1.  The  best  are  killed. 

2.  The  worst  are  left  at  home. 

3.  Women  are  affected. 

4.  Single  men  are  lost. 

5.  Military  training  is  not  transmissible  (not  hereditary). 

6.  After-effects  on  home  coming,  limitations,  etc.,  13.8  per  cent,  of  the 
population  of  Britain — that  is,  6,250,000  men — are  between  the  ages  of 
1 8  and  45,  the  period  of  military  service.    When  one-third  or  more,  likely 
one-half,  of  these  are  taken  from  their  homes,  from  their  field  of  productive 
activity,  it  is  not  difficult  to  understand  that  the  effects  must  set  back 
the  development  of  the  race  and  civilization. 

The  wars  of  today  are  not  the  tribal  affairs  of  yore.  The 
latter  did  in  a  way  eliminate  the  weaker,  the  cowardly.  But 
the  modern  war,  in  which  we  have  the  volunteer,  eliminates 
the  virile,  the  strong.  He  suggests  that  the  struggle  for  sur- 
vival may  mean  a  sharpening  of  the  teeth  and  claws,  or  it 
may  mean  the  fostering  care  of  parents — subordinating  self- 
preservation  to  the  interests  of  the  race.  That  is,  cooperation 
rather  than  competition  may  be  the  method.  Rather  than 
an  advanced  state,  war  seems  more  properly  considered  a 
reversion  to  the  primitive. 

If,  as  some  claim,  the  loss  is  confined  to  men,  and  that  the 
good  strong  stock  of  women  remain,  it  should  also  be  remem- 
bered that  if  the  latter  propagate  they  must  marry  the  infe- 
riors left  at  home  and  thus  the  germ  plasm  will  be  tainted  with 
a  weak  strain. 

War  Not  a  Natural  Agent. — Thomson  rightly  claims  that 
environment  is  hardly  comparable  with  war  as  a  natural 
selective  agency.  As  Dr.  Sargent  has  pointed  out,  struggle  is 
a  biological  necessity,  for  the  life  of  the  body  as  a  whole 
depends  upon  it.  But  war  is  not  such  a  struggle  and  is  not 
necessary  unless  the  life  of  the  nation  is  threatened  by  starva- 
tion, internal  uprisings,  or  invasion  of  an  avowed  enemy.  (206) 

The  aeroplane,  submarine,  machine  guns,  long  range  cannon, 
have  changed  the  character  of  war.  Now  there  is  little  oppor- 
tunity for  personal  prowess.  Burrowing,  trenching,  ditching, 


HYGIENE     AND     WAR 

shooting  from  under  cover  have  made  engagements  now  stupid 
and  dull.  Naval  battles  are  at  long  range.  This,  he  states, 
tends  to  promote  Asiatic  fatalism.  It  is  not  fit  material  for 
the  development  of  courage.  This  can  be  done  better  through 
proper  exercise  and  athletics. 

Some  Probable  Benefits. — Thomson  urges  care  in  the  employ- 
ment of  children  under  this  war  stress.  Keep  them  under  as 
normal  condition  as  possible.  He  says:  "There  is  patriotism 
in  dying  for  our  country;  there  is  a  conceivable  patriotism  in 
marrying  for  her  and  bearing  children  for  her."  We  must 
watch  the  birth  rate.  Perhaps  in  a  positive  way  the  war  may 
aid  eugenics  by  calling  attention  to  wastage  from  other  sources, 
as  tuberculosis.  "Let  us  prune  our  comforts  before  we  pinch 
our  souls.  Let  us  keep  up  art,  music,  etc.,  as  much  as  possible." 
Do  not  cripple  the  supermen.  He  says  that  the  following  re- 
sults may  be  expected :  The  war 

1.  Will  demonstrate  the  need  and  value  of  sound  constitutions; 

2.  May  cause  the  inertia  of  present  enthusiasms  to  function  in  ideals 
operative  in  the  future; 

3.  May  give  an  increased  sense  of  solidarity  among  self-governing  domin- 
ions of  the  British  Empire. 

In  substance,  Dr.  Rosenthal  gives  the  following  facts  with 
reference  to  war  and  the  protection  of  mothers. 

The  increase  of  the  weekly  allowance  during  the  war  by  order  of  the 
federal  council  of  December  3,  1914,  and  the  fuller  order  of  January  28, 
1915,  for  the  protection  of  mothers  is  of  special  significance.  (197) 

1.  The  husband  must  render  military  service  or  in  consequence  of  the 
war  be  deprived  of  the  resumption  of  his  means  of  sustenance. 

2.  He  must  have  been  ill  during  a  definite  time. 

The  amount  of  this,  measured  according  to  wealth  and  the  sick  fund,  is 
not  a  new  operation. 

1.  To  cover  cost  of  confinement 25  marks 

2.  An  allowance  of        56  marks  weekly 

3.  An  allowance  for  the  period  of  pregnancy  of 10  marks 

4.  Up  to  the  1 2th  week  after  birth  50  pf.  (a  final  Stillgeld) 

He  urges  the  necessity  of  taking  care  of  the  mothers  of 
industrial  classes  during  the  war. 

War  Babies. — We  have  heard  considerable  about  'war 
babies',  illegitimates,  etc.  The  term  'war  babies'  is  used 

[147] 


HYGIENE     AND     WAR 

with  two  significations.  By  some,  it  is  used  to  designate 
illegitimate  children  born  through  the  lust  of  soldiers,  chiefly 
those  at  recruiting  stations.  In  general,  as  used  in  England, 
the  term  applies  to  children  born  of  soldiers'  wives.  (328, 

329,  330) 

In  Germany  and  England  efforts  have  been  made  to  have 
the  departing  soldiers  marry  properly.  Hence  we  hear  the 
term  'war  babies'  used  frequently.  This  is  a  commendable 
move. 

Ronald  McNeill  thinks  that  an  enormous  number  of  illegiti- 
mate children  are  about  to  be  born.  He  wishes  to  make  these 
wards  of  the  state.  While  such  a  procedure  is  difficult,  he 
thinks  means  should  be  employed  whereby  the  children  of 
the  heroes  of  Marne  et  at.  will  not  be  stigmatized.  (124,  190, 

329»  330) 

A  rather  careful  investigation  of  the  subject  of  illegitimacy 
and  sexual  intercourse  among  the  soldiers  has  shown  that 
the  heroes  of  Marne  have  no  such  taint  as  might  be  inferred 
from  McNeill's  statements,  and  that  the  birth  rate  is  not  at 
all  above  normal  in  the  regions  of  the  recruiting  and  training 
stations  or  camps. 

War  and  Sexual  Life. — We  present  in  substance  Teuton's 
discussion  of  'Sexual  Life  and  Warfare' : 

What  becomes  of  the  women  with  whom  the  large  part  of 
men  in  the  field  have  had  intercourse,  legally  and  otherwise, 
before  leaving  home  for  the  front? 

It  must  follow  that  reputable  wives  thrown  into  a  state  of 
continence  are  affected  differently  from  those  in  the  condition 
of  elderly  and  young  virgins,  etc.  For  some  of  the  former 
it  is  perhaps  good,  as  it  fits  in  with  their  condition.  But  wives 
of  about  thirty  often  suffer  from  the  absence  of  their  hus- 
bands, developing  neurasthenia  and  hysteria. 

He  claims  that  many  seek  to  be  nurses  merely  that  they 
may  be  with  soldiers. 

He  found  that  many  nurses,  or  those  calling  themselves 
such,  were  recently  found  infected  with  venereal  diseases  from 
the  soldiers. 

[148] 


HYGIENE     AND     WAR 

What  has  become  of  the  camp  follower  (female)  of  former 
wars?  He  thinks  she  has  emigrated  to  neutral  countries  when 
able.  Many  starve.  Some  change  their  calling.  In  cases  of 
invasion,  "In  regard  to  outrages  or  harsh  treatment  of 
women  of  the  conquered,  the  author  is  at  much  pains  to 
introduce  a  sadistic  element  to  explain  them.  The  latter  is 
believed  to  be  always  present  in  normal  sexual  relations.  Lust 
is  heightened  if  pain  and  humiliation  can  be  inflicted  upon 
the  women.  War  calls  forth  the  latent  sadistic  impulses. 
Sadism  is  less  marked  in  women,  but  in  warfare  mutilations 
are  practised  on  the  invading  soldiers  which  in  times  of  peace 
would  be  reserved  for  faithless  lovers." 

"-'.  .  .  war  is  to  some  extent  an  unaphrodisiac  for  the 
soldiers,  for  fornication  usually  accompanies  high  living  and 
idleness."  Soldiers  are  kept  busier  now  than  in  ancient 
times.  (236) 

Influence  of  War  on  the  Race. — We  have  pointed  out  that 
there  are  still  some  who  believe  that  war  makes  for  the  better- 
ment of  the  race,  and  in  our  section  on  eugenics  we  have 
stated  some  of  their  positions.  They  usually  present  no  facts 
upon  which  such  conclusions  can  be  based.  In  all  candor, 
we  have  to  state  that  scientific  facts,  either  pro  or  con,  of  a 
true  biological  nature  are  very  meager.  Yet  such  as  we  have 
and  the  inferences  from  them,  which  seem  logical,  lead  us  to 
the  conclusion  that  the  best  blood  of  the  nation  is  lost.  Not 
all  of  it,  of  course,  but  in  such  quantities  as  to  impair  the 
race.  We  are  not  prepared  to  accept  the  questionnaire 
method  in  the  solution  of  this  question,  as  used  by  Jordan  and 
Jordan  (114).  But  there  are  facts  which  warrant  their  pre- 
sumptions relative  to  the  Civil  War,  namely,  in  substance: 

1.  That  our  volunteers  represented  a  better  human  element  than  con- 
scripts, for  they  enlisted  earlier,  became  the  leaders,  served  longest,  were 
more  exposed,  hence  were  lost  in  a  greater  proportion. 

2.  That  the  conscripts  of  the  later  periods  saw  less  service,  suffered  less 
exposure,  hence  survived  in  greater  numbers.    Thus  they  were  left  to  per- 
petuate their  kind — the  weak  kind  at  that. 

3.  That  those  exempted  for  physical  and  other  reasons,  the  residue,  were 
free  to  reproduce  their  kind. 

[H9] 


HYGIENE     AND     WAR 

"The  flower  of  the  people  went  into  the  war  at  the  beginning,  and  of  these 
a  large  part  died  before  the  end,"  says  these  authors. 

They  point  out,  as  we  have  done,  the  difficulty  of  obtaining 
facts,  saying: 

In  conclusion,  we  are  impressed  that  with  respect  to  the  eugenic  aspect  of 
the  Civil  War  we  are  dealing  with  matters  insusceptible  of  precise  deter- 
mination. 

Our  discussion  of  the  recruit  and  his  training,  as  well  as 
our  direct  quotation  from  Chambers  and  others,  shows  that  the 
European  conflict  is  taking  the  best.  In  modern  wars  this 
must  ever  be  so.  No  state  can  maintain  in  time  of  peace  the 
size  of  army  seemingly  thought  necessary  for  war.  Hence 
war  depends,  as  we  have  shown,  on  the  general  population. 
It  demands  and  takes  the  best  from  these  civilians.  The  many 
measures  suggested  in  England  and  Germany  providing  for 
the  marriage  of  the  fit  ere  they  leave  for  the  front  is  a  tacit 
admission  of  the  need  of  providing  some  means  of  sustaining 
the  best  blood  of  the  nation.  Schiller  was  correct  when  he 
stated,  "Immer  der  Krieg  die  Besten  verschlingt."  "(War 
always  destroys  the  best.") 

Jordan  points  out  that  eugenic  or  racial  decline  may  arise 
from 

1.  Destruction  of  the  fittest,  through  war  or  other  causes  producing 
contra-selection  or  reversal  of  selection. 

2.  Emigration,  by  which  the  most  energetic  or  enterprising  pass  on  to 
other  regions  or  in  search  of  larger  opportunities. 

3.  Immigration,  by  which  the  vacancies  are  filled  by  weaker  stock,  the 
beaten  men  of  the  beaten  race,    (no,  in,  112,  113,  114) 

Greece  declined  when  her  best  blood  was  lost  through  her 
wars,  foreign  and  domestic,  and  the  former  slaves  came  in  to 
rule. 

"The  Roman  Empire,"  says  Seeley,  "perished  for  want  of 
men."  That  is,  she  selected  her  best,,  her  blue-blooded,  to 
carry  on  her  conquests  and  that  to  such  an  extent  that  the 
stock  was  depleted  and  the  unfit  left  to  propagate  their  kind. 
Hence  the  ignoble  offspring  were  unable  to  cope  with  the 
barbarians  of  the  North. 

He  suggests  that  Lucerne  gave  her  best  to  sustain  France 
and  that  today  it  seems  to  him  the  men  of  that  province 

[150] 


HYGIENE     AND     WAR 

represent  a  lower  type.  He  points  out  that  certain  ailments 
(goiter,  for  example)  were  encouraged  because  they  incapaci- 
tated men  for  military  service  and  that  the  women  refused 
to  give  the  male  children  drugs  which  might  effect  a  cure. 
Thus  cretinism  was  fostered  in  certain  regions  and  the  pro- 
duction of  offspring  with  a  tendency  to  this  disease  encouraged. 
The  strong,  vigorous  men  were  hired  as  mercenary  soldiers  to 
other  European  states.  Spain  paid  the  cost  of  imperialism  by 
sacrificing  her  best  blood  until  she  is  but  a  relic  of  her  former 
greatness.  He  emphasizes  the  fact  that  Kipling  has  sensed 
the  awful  sacrifice  England  has  paid  for  her  colonies  in  the 
loss  of  her  best  blood  to  obtain  and  maintain  them. 

In  speaking  of  Rome's  decline  he  says,  "Berry  states  that 
an  'effect  of  the  wars  was  that  the  ranks  of  the  small  farmers 
were  decimated  while  the  number  of  slaves  who  did  not  serve 
in  the  army  multiplied'.  Thus  Vir  gave  place  to  Homo,  'real 
men  to  mere  human  beings'." 

Such  facts  as  these  show  that  while  war,  if  continued  long 
enough,  draws  on  all  regardless  of  quality,  nevertheless,  the 
best  go  first  and  suffer  most  so  that  the  good  stock  of  blood 
is  diminished  in  greater  ratio  than  the  poorer.  We  are  pre- 
pared to  believe,  of  course,  that  good  blood  survived  our  ter- 
rific Civil  War.  But  the  fund  of  it  certainly  was  diminished  by 
the  scourge  through  which  we  passed.  A  study  of  the  increase 
of  population  from  1840  to  1870,  will  show  that  the  war  had 
a  deteriorating  effect.  Not  only  was  emigration  discouraged, 
but  the  natural  increase  of  the  native  stock  failed  to  measure 
up  to  the  rate  which  might  have  been  expected  had  the  war 
not  occurred.  It  should  be  noted  that  however  good  the 
remaining  stock — the  survivors — may  be,  that  fact  of  itself 
cannot  replace  the  lost  blood  of  the  nation. 

Walker,  Superintendent  of  the  Ninth  Census,  says  of  the 
retardation  of  the  national  increase  found  in  1870,  that  it 
arose  from  the  following  probable  causes:  (164,  vol.  I,  p. xviii.) 

But  for  the  war  and  for  causes  which,  whether  due  to  the  war  or  not, 
came  in  at  nearly  the  same  time,  the  population  of  the  United  States  might 
have  been  expected,  according  to  ascertained  rate  of  increase,  to  be  in  the 

[151] 


HYGIENE     AND     WAR 


neighborhood  of  forty-one  and  one-half  millions  on  the  first  of  June,  1870. 
The  rule  of  geometrical  progression,  has  indeed  been  invoked  by  some  to 
prove  that  our  population,  but  for  the  war,  would  have  reached  forty-two 
and  one-half  millions.  Walker  thinks  this  rule  is  not  so  good  as  the  rule  of 
second  differences. 


- 

1830 

1840 

1850 

1860 

1870 

POPULATION.... 

12,866,020 

17,069,453 

23,191,876 

31,399,300 

41,609,000 

First  Difference  

4,203,433 

6,122,423 

8,207,424 

10,209,700 

Second  Difference  .  . 

1,918,990 

2,085,001 

2,002,000 

Indians  excluded,  as  previously. 

It  will  require  but  a  brief  review  of  the  notorious  and  palpable  effects  of 
war  to  account  for  the  three  millions  which  make  up  the  difference  between 
the  population  of  the  country  as  projected  from  previous  experience  and 
the  population  shown  by  the  census. 

FIRST.  Retardation  of  Increase  in  Colored  Population.  Walker  points 
out  that  the  natural  increase  should  have  approximated  one  million  whereas 
it  was  but  438,179.  Continuing  his  explanation,  "Drawn  largely  from  the 
plantations,  where  their  increase  was  natural,  rapid  and  sure,  to  cities  and 
camps,  where  want,  vice  and  pestilence  made  short  work  of  the  multitudes 
hastily  gathered,  inadequately  provided  for,  and  left  for  the  first  time  to 
their  own  control,  while  so  much  of  the  impulse  to  procreation  as  depended 
on  the  profits  of  slave-breeding  was  withdrawn  by  the  abolition  of  chat- 
telism,  it  is  only  to  be  wondered  at  that  the  colored  people  of  the  South 
have  held  their  own  in  the  ten  years  since  1860." 

SECOND.  Direct  Loss  by  Wounds  and  Disease.  At  least  304,000  men 
of  the  Union  army  died  during  period  of  service  (see  former  statistics). 
Over  285,000  were  discharged  for  medical  disability.  It  is  but  a  fair  esti- 
mate to  state  that  of  these  probably  one-third,  95,000,  also  died.  "Tens  of 
thousands  were  discharged  to  die;  tens  of  thousands  died  within  the  first 
few  months  after  discharge.  Tens  of  thousands  lingered  through  the  first  or 
second  year.  If  in  addition  to  these  numbers,  we  allow  for  the  accelerated 
mortality  of  the  two  million  persons  enlisted  in  the  service  of  the  United 
States  who  neither  died  in  service  nor  were  discharged  for  disability,  but 
who  carried  with  them  the  seeds  of  disease  contracted  under  hardships  and 
exposure  of  campaigns,  or  returned  to  civil  life  with  shattered  constitutions 
though  with  no  developed  disease,  500,000  will  surely  be  a  moderate  esti- 
mate for  the  direct  losses  among  the  Union  armies." 

[152] 


HYGIENE     AND     WAR 

The  probable  losses  of  the  Southern  armies  were  at  least  350,000.  "We 
reach,,  therefore,  the  total  result  of  a  direct  loss  to  the  male  population  of 
the  country  of  not  less  than  850,000.  Popular  opinion  would  undoubtedly 
place  this  total  higher,  and  in  such  a  matter,  popular  judgments  are  quite 
as  likely  to  be  correct  as  judgments  formed  from  the  contemplation  of 
statistical  data  necessarily  partial  and  incomplete." 

And  these  facts  do  not  express  at  all  the  loss  among  the 
civilian  population,  the  sufferers  at  home. 

THIRD.  The  Indirect  Loss  by  the  War  in  the  Check  given  to  the 
Native  Population. 

There  were  in  the  North  over  one  and  one-half  million  men 
drawn  from  domestic  life  for  a  period  of  three  years;  in  the 
South  probably  about  one  million  men  for  the  same  period. 
Of  these  perhaps  one-half  were  unmarried  and  their  relations 
during  these  four  years  were  such  as  to  discourage  and  pre- 
vent the  formation  of  domestic  relations  then  and  in  subse- 
quent times.  The  other  portion,  separated  from  their  families, 
were  also  prevented  from  fulfilling  the  marital  relation.  We 
have  here  an  important  factor  in  deterioration  of  population, 
in  both  quality  and  quantity.  These  men  were  between  the 
ages  of  1 8  and  45 — years  of  productivity.  In  the  South  they 
were  taken  even  younger;  at  a  time  when  least  able  to  endure 
strain. 

FOURTH.     Indirect  Loss  by  the  War  in  the  Check  to  Immigration. 

For  the  four  years  preceding  the  war  the  number  thus  enter- 
ing our  country  was  649,354;  during  the  four  years  of  the 
war,  it  was  553,605;  while  in  the  four  subsequent  years  it 
was  1,163,128.  Hence  there  was  probably  a  loss  of  some 
350,000  from  this  source. 

FIFTH.     Habits  of  Life  in  Sections  of  the  Country. 

Walker  has  pointed  out  that  the  increasing  tendency  to  luxu- 
rious life,  to  urban  in  contrast  to  rural  life,  to  lack  of  the  de- 
sire for  children,  etc.,  were  factors  making  for  a  lower  ratio  of 
increase  in  population. 

[153] 


HYGIENE     AND     WAR 

In  the  light  of  the  facts  afforded  by  the  investigations  of 
the  Balkan  Commission  and  revealed  by  the  trend  of  the  his- 
tory of  imperialistic  nations,  as  well  as  in  consideration  of  the 
character  of  the  English,  French,  Germans,  Russians,  Italians, 
etc.,  who  are  forming  the  great  armies  of  the  present  struggles, 
it  seems  evident  that  the  best  blood  of  the  nations  is  being 
lost  and — remembering  the  usual  results  of  wars — wasted. 


[154] 


VI.   BENEFITS   TO   THE   GENERAL 
POPULATION    IF:— 

a.  It  should  follow  as  efficiently  as  soldiers,  the  training 
and  care  the  latter  have  in  hygiene;  and 

b.  The  efforts  now  expended  upon  soldiers  alone,  were  ex- 
pended upon  the  general  public. 

FUNCTION  OF  WAR  IN  HYGIENE 

War  serves  to  point  out  the  particular  hygienic  and  sani- 
tary factors  which  reduce  its  horrors  and  make  possible  the 
successful  accomplishment  of  its  purposes.  In  this  sense,  it  is 
a  benefit  to  mankind,  but  at  such  a  fearful  cost  that  it  would 
seem  that  calm,  careful  consideration  of  the  same  factors  and 
daily  observance  of  them  would  accomplish  much  more  with 
less  effort  and  expenditure.  We  should  remember  that  the 
progress  of  military  hygiene  and  sanitation,  though  stimu- 
lated perhaps  by  war,  has  been  possible  only  in  times  of 
peace.  The  study  of  typhus,  typhoid,  etc.,  was  made,  not 
during  war  times  but  in  peace,  and  the  efficiency  of  treatment 
depends  upon  following  proper  measures  at  all  times.  Yellow 
fever  was  investigated,  conquered,  and  driven  from  Havana, 
New  Orleans,  and  Panama  during  a  period  of  peace.  So,  too, 
with  the  conquest  of  malaria,  beri-beri,  cholera,  etc. 

During  the  occupation  of  Vera  Cruz  by  the  United  States 
army  from  April  24  to  Nov.  23,  1914,  there  was  smallpox 
among  the  citizens,  with  little  or  no  vaccination;  flies  were 
numerous  from  lack  of  proper  scavenging;  tuberculosis  was 
prevalent  and  there  were  some  cases  of  cerebro-spinal  menin- 
gitis ;  the  malarial  season  was  due.  The  houses  to  be  used  for 
barracks  were  immediately  cleaned  and  disinfected.  The  com- 
panies' kitchens  and  mess-rooms  were  screened.  As  a  pro- 
phylactic, 3  grains  sulfate  of  quinine  were  given  daily  to  each 
man.  Provision  was  made  for  the  proper  disposal  of  sewage 
and  garbage.  The  latrines  dug  were  made  fly-proof  and  were 


HYGIENE     AND     WAR 

burnt  out  twice  daily  with  7^  K>s-  of  hay  to  I  gal.  crude  oil. 
Manure  and  rubbish  were  sent  to  the  destroyers.  The  picket 
lines  were  kept  cleaned  and  burned  over  once  a  week.  Baths 
were  installed;  69,000  gals,  of  crude  oil  were  used  on  the 
stagnant  water  of  the  neighborhood;  61  miles  of  drainage 
ditch  were  dug;  46,420  vaccinations  were  performed.  The 
city  was  inspected  every  five  days  and  the  food  was  regularly 
examined.  The  deaths  from  malaria  fell  to  one- tenth  of  the 
average.  Prophylactic  packets  for  venereal  diseases  were 
issued  to  civilians  as  well  as  soldiers.  Suspected  women  were 
examined  weekly.  It  was  found  that  of  the  registered  women 
25%,  and  of  the  clandestine  prostitutes  90%,  were  diseased. 
The  army  had  during  this  period,  no  cases  of  typhoid,  no 
cerebro-spinal  meningitis.  Such  cases  of  dysentery  as  occurred 
were  fly-caused.  There  was  one  death  from  this  disease. 
Such  results  probably  could  not  have  been  accomplished  under 
stress  of  war.  (22,  297) 

Training  of  the  Soldier. — Advocates  of  militarism  have 
pointed  to  the  great  benefits  to  be  derived  from  military  train- 
ing. The  conditions  under  which  this  training  is  taken  have 
warranted  such  a  conclusion.  It  should  be  observed,  however, 
that  should  civilians  follow  the  same  methods  with  the  same 
degree  of  tenacity  and  spirit — as  many  do — the  result  would 
be  even  greater  than  is  possible  under  the  stress  of  war.  For 
as  we  have  already  shown,  the  previous  hygienic  training  of 
the  general  population  of  Germany  and  Great  Britain  has 
resulted  in  the  acceptance  of  more  applicants  under  most 
strenuous  physical  requirements  and  has  lessened  the  amount 
of  preliminary  practice  necessary  to  make  efficient  soldiers  of 
active  men  whose  lives  have  been  spent  in  labor,  business 
professions,  etc..  War  serves  but  to  emphasize  the  factors 
which  should  function  at  all  times.  It  shows  how  costly  the 
neglect  of  health  may  be,  not  only  in  war  but  in  peace.  The 
warrior  of  today  of  necessity  must  have  been  the  citizen  of 
yesterday.  War  serves  to  show  forcibly  the  need  of  following 
simple  laws  of  health,  of  obeying  the  seemingly  trite  rules  of 
hygiene.  (8,  32,  91,  92,  106,  208,  239,  243,  249,  260) 

[156] 


HYGIENE     AND     WAR 

Personal  Hygiene. — From  this  it  is  easily  seen  how  important 
it  is  that  the  soldier  pay  attention  to  his  personal  hygiene. 
This  means  cleanliness  of  person,  hence  care  of  the  body  and 
mind.  For  the  accomplishment  of  this,  training  of  such  a 
nature  as  to  fix  correct  habits  must  be  given.  Men  of  roving, 
discontented,  unambitious  natures  do  not  make  good  soldiers. 
Men  who  have  been  accustomed  to  home  comforts  may  suffer 
much  from  nostalgia.  For  such  it  is  necessary  to  supply  that 
which  will  occupy  their  minds  and  bodies  to  the  exclusion  of 
insistent  recollections  of  home  and  its  ties.  Crowded  together 
as  they  must  be,  it  is  more  essential  that  each  keep  his  person 
as  clean  as  possible.  One  man  can  scatter  disease-carrying 
vermin  through  a  whole  battalion,  thence  through  the  corps 
and  army.  An  illustration  of  the  persistence  of  racial  habits 
formed  in  time  of  peace  is  shown  in  the  fact  that  in  certain  of 
the  trenches  held  by  the  English,  vermin  give  little  trouble; 
while  in  sections  held  by  other  troops  the  vermin  become  a 
pest.  Military  hygienists  attribute  this  freedom  of  the 
English  troops  to  their  habit  of  taking  baths,  cold  water 
especially,  at  all  times  and  under  all  sorts  of  conditions.  The 
difficulty  of  eradicating  vermin  when  once  they  are  started 
among  troops  is  due  to  the  utter  impossibility  of  having  ade- 
quate bathing  facilities  for  the  men  and  for  washing  and  dis- 
infecting their  clothing  in  camp  and  under  battlefield  condi- 
tions. Army  life  is  conducive  to  the  development  of  certain 
skin  diseases  which  can  be  controlled  only  through  extreme 
cleanliness.  (116,  133,  220,  362,  440) 

Bathing. — The  soldier  then  should  habituate  himself  to 
bathing  often.  If  it  is  impossible  to  take  a  daily  warm  or  cold 
bath,  he  should  at  least  cleanse  the  arm-pits,  the  crotch,  the 
feet,  face,  and  hands.  To  avoid  infection,  he  should  wash  the 
hands  after  defecation  or  urination.  If  water  is  not  available, 
he  should  take  a  dry  rub  with  a  coarse  towel.  The  scalp 
should  be  washed  at  least  once  or  twice  per  month  and  given 
a  daily  rub  with  the  fingers  or  a  brush.  With  a  little  ingenuity, 
various  sorts  of  baths  can  be  rigged  up.  The  English  troops 
have  succeeded  in  making  a  sort  of  shower  bath  by  means  of 

[157] 


HYGIENE     AND     WAR 

which  four  times  as  many  soldiers  can  take  baths  with  the 
use  of  about  one-fourth  the  amount  of  water  as  in  tubs. 

Teeth. — The  soldier  is  a  fighting  engine  whose  efficiency  will 
depend  upon  the  number  of  calories  it  is  able  to  get  out  of  the 
food  taken  in.  Physiology  has  shown  that  proper  mastication 
is  necessary  to  obtain  the  maximum.  But  the  important  tools 
of  mastication  are  the  teeth.  Hence  they  should  be  in  good 
shape  and  kept  that  way.  It  is  for  this  reason  that  special 
dental  corps  have  been  advocated  for  the  treatment  and  care 
of  the  soldier.  As  showing  how  habit  functions,  we  may  re- 
peat that  the  Japanese  carried  their  tooth-brushes  with  them 
incessantly  as  a  part  of  their  equipment,  quite  as  essential  as 
their  weapons.  In  contrast,  the  English,  who  have  not  learned 
the  same  stoical  sort  of  obedience,  left  theirs  behind  in  their 
retreat  towards  Paris. 

Clothing. — It  should  be  remembered  that  dirty  underclothes 
chafe.  Chafing  is  not  only  an  irritation,  but  also  consumes 
caloric  energy  wastefully.  If  possible  the  underclothes  should 
be  changed  every  day  or  every  other  day,  those  worn  should 
at  least  be  removed,  dried,  and  rubbed  thoroughly.  When  pos- 
sible use  soap  in  washing  the  body  and  clothing.  Since  part 
of  the  clothing  is  of  wool,  special  care  should  be  exercised  in 
washing,  else  the  garments  may  shrink,  become  hard  and  thus 
cause  irritation.  For  this  reason  they  should  be  washed  in 
cold  water  and  not  wrung  out.  When  water  is  not  available, 
the  garments  should  be  dried,  rubbed,  or  beaten,  and  hung  in 
the  air.  If  this  is  done  in  sunlight,  the  result  will  be  a  species 
of  excellent  disinfection,  as  the  sun's  rays  are  fatal  to  many 
germs.  (116,  133,  259,  260) 

Diet  and  Eating. — The  soldier  should  be  able  to  cook  his  own 
food  for  he  may  be  thrown  upon  his  own  resources  at  any 
time.  The  lessons  of  the  past  with  reference  to  the  extreme 
necessity  of  proper  feeding  have  been  learned;  this  branch  of 
the  service  is  well  organized.  Instead  of  being  expected  to 
get  his  meal  after  everything  else  has  been  attended  to,  his 
meals  are  made  as  regular  as  possible.  On  the  march,  the 
first  line  of  transports  carries  everything  essential  to  the  wel- 


HYGIENE     AND     WAR 

fare  of  troops.  The  second  line  carries  the  baggage  train  and 
material  not  immediately  needed.  Camp  kettles  are  expected 
to  reach  the  front  with  the  first  unit  and  to  be  put  into  action 
at  once,  so  that  the  meal  is  ready  at  least  within  two  hours 
after  the  arrival  of  troops  in  camp.  Smokeless,  traveling  kitch- 
ens— some  drawn  by  two  horses  and  capable  of  cooking  for 
250  men — are  being  used  extensively.  These  can  be  started 
with  the  beginning  of  the  march  and  be  ready  for  serving  soon 
after  halting.  (133,  ch.  III.) 

One  writer  states  that  the  body  needs  about  3,000  calories 
of  which  2,400  are  for  heat.  Whether  the  body  is  at  work  or 
at  rest,  it  is  necessary  to  maintain  a  certain  heat  equilibrium. 
For  this  reason  the  heat  must  not  be  allowed  to  accumulate  in 
the  body.  Nature's  way  of  taking  care  of  this  is  through  evapo- 
ration, radiation,  conduction,  urination,  and  respiration.  He 
claims  that  the  optimum  condition  of  marching  is  a  temperature 
of  100.5  deg.  Fahr.  with  a  maximum  of  102  deg.  Fahr.  Increase 
over  this  is  dangerous.  Now  it  has  been  found  that  the  soldier 
loses  about  a  quart  of  water  in  every  7%  miles  marched  under 
average  conditions.  The  loss  of  I  gallon  is  dangerous  and  of 
iX  gallons  results  in  death.  Hence  the  necessity  of  the  sol- 
dier's taking  in  water,  in  certain  amounts  at  intervals.  The 
data  indicate  that  about  one  quart  of  water  is  needed  for 
every  73^  miles.  It  is  quite  necessary  to  have  the  soldier  form 
the  habit  of  drinking  such  amounts  at  such  intervals  and 
avoid  drinking  between  times.  It  is  well  to  take  copious 
drinks  of  sugared  hot  tea  or  coffee  preceding  a  march.  The 
old  idea  of  sucking  a  pebble  is  good  because  under  these  con- 
ditions the  individual  will  probably  keep  his  mouth  shut,  thus 
keeping  out  dust  and  preventing  dryness  of  the  throat.  (133, 
ch.  Ill;  116,  259,  260.) 

As  a  general  rule  neither  civilian  nor  soldier  drinks  sufficient 
water.  Keefer  advocates  the  drinking  of  from  six  to  eight 
glasses  of  water  per  day.  This  tends  to  irrigate  the  kidneys 
and  to  prevent  constipation  which  gives  rise  to  biliousness, 
piles,  headaches,  and  mental  depression. 

Preceding  a  strenuous  march  or  action,  the  soldier  should 

[159] 


HYGIENE     AND     WAR 

eat  a  large  meal.  So  far  as  possible  the  heavy  meal  should 
come  toward  the  close  of  the  day.  Nor  should  the  soldier 
after  marching  all  day  have  to  wait  a  long  period  for  his  meal, 
say  two  hours.  For  his  state  of  fatigue  may  be  such,  that  by 
this  time  he  will  be  asleep  and  will  prefer  to  forego  his  food 
rather  than  wake  up.  The  final  result  may  be  that  he  will 
form  the  habit  of  neglecting  to  eat  properly  at  correct  intervals. 

While  his  previous  training  as  a  civilian  may  have  caused 
him  to  avoid  extravagance  in  eating,  there  may  be  a  tendency 
to  let  down  the  bars  of  inhibition  under  the  emotional  strain 
of  a  city  conquered  and  invested  and  to  indulge  in  excesses. 
It  is  impossible  to  fix  too  firmly  the  habit  of  temperance  in  all 
things.  It  should  be  impressed  upon  him  that  excess  in  eating 
leads  to  biliousness,  to  forms  of  dyspepsia,  or  to  excessive 
waste,  and  that  such  waste  has  an  irritating  effect  upon  the 
kidneys,  often  causing  gout,  obesity,  and  hardening  of  the 
arteries.  Beefy,  overfed  men  are  liable  to  apoplexy. 

Keefer  has  put  forth  the  following  'Dietary  Dont's  for  the 
Soldier': 

1.  Don't  Fletcherize  to  an  extreme — avoid  fads. 

2.  Don't  eat  hurriedly. 

3.  Don't  swallow  a  morsel  till  it  is  thoroughly  broken  up  and  mixed 
with  saliva  by  chewing. 

4.  Don't  overload  your  stomach — get  up  from  the  table  feeling  that 
you  could  eat  a  little  more  with  a  relish. 

5.  Don't  eat  unripe  or  over-ripe  fruit. 

6.  Don't  eat  anything  while  away  from  camp  or  barracks  whose  material 
or  preparation  may  seem  questionable. 

7.  Don't  bring  worry  or  'grouch'  to  table  with  you. 

Other  Factors.— The  old  admonition  to  get  plenty  of  fresh 
air  should  be  urged  upon  the  soldier.  Drafts  do  not  give  colds. 
Colds  are  germ-caused. 

Busy  as  the  life  of  the  soldier  may  be  in  war  times,  even  he 
needs  variety  in  the  form  of  exercise  to  keep  his  mind  and 
body  in  the  highest  stage  of  efficiency.  This  means  that 
recreation  should  be  a  regular  part  of  his  round  of  occupations. 
Card  playing,  physical  games,  etc.,  are  necessities  of  his  life. 

[160] 


HYGIENE     AND     WAR 

The  long,  tedious  waits  in  the  trenches  are  much  more  trying 
than  the  charges,  the  movements  of  battle,  or  the  march.  For 
such  periods,  diversions  of  a  recreative  sort  should  be  provided. 

Temperance  in  all  things  is  necessary.  The  soldiers  should 
be  shown  that  sexual  indulgence  is  not  necessary  for  health 
and  is  especially  dangerous  under  the  conditions  in  which  he 
is  living. 

And  though  battles  occur  at  all  times,  even  the  soldier  must 
rest.  He  should  have  eight  hours'  sleep  per  day  and  should 
be  so  drilled  that  he  can  take  it  whenever  opportunity  presents 
itself. 

Not  only  should  he  fulfill  the  canons  of  cleanliness  himself 
but  he  should  demand  their  fulfilment  by  those  about  him.  In 
fact,  it  is  impossible  for  him  to  keep  clean  unless  his  associates 
do  the  same. 

Physical  Training. — "To  develop  a  complete  man  is  the 
function  of  military  hygiene,"  writes  one  author.  How  famil- 
iar this  sounds ! — for  such  is  the  function  of  all  true  education. 
It  merely  emphasizes  the  fact  that  the  fully  developed  man 
is  the  one  best  prepared  for  this  as  for  every  other  exigency 
of  life. 

Woodhull  says  the  function  of  drill  is  to  give  the  recruit  the 
essential  knowledge  of  maneuvering,  etc.,  and  to  harden  and 
prepare  him  for  real  work.  This  drill  should  be  within  the 
powers  of  the  recruit;  should  he  fail  to  show  signs  of  proper 
adjustment  he  should  be  turned  over  to  a  medical  officer. 
The  development  should  be  gradual,  for  such  training  cannot 
be  hastened.  Woodhull  is  considering  the  usual  type  enlisting 
in  peace  times  and  not  the  finer  qualities  of  the  modern  volun- 
teer soldier,  (n,  116,  121,  133,  183,  259,  260,  439b  and  h) 

Keefer  and  Major  Lelean  both  call  attention  to  the  impor- 
tance of  considering  the  psychic  as  well  as  the  bodily  make-up 
of  the  soldier.  The  interplay  of  the  physical  and  psychical 
factors,  hitherto  only  cursorily  considered,  is  receiving  much 
attention.  Its  significance  has  been  in  evidence  many  times 
in  the  trenches,  among  the  wounded,  and  in  actions.  The 
demands  upon  the  intelligence  are  greater  than  formerly  and 

fi6il 


HYGIENE     AND     WAR 

the  warrior  of  today  must  not  only  be  organically  sound  but 
must  possess  more  than  the  average  strength,  endurance,  and 
organic  vigor.  As  Keefer  points  out,  he  must  be  trained  to 
husband  his  energy,  to  become  confident,  skilled,  self-reliant, 
and  courageous;  for  which  smartness,  agility,  and  precision 
are  needed.  These  combined  constitute  discipline.  Surely  we 
need  training  in  everyday  life  that  will  give  us  such  results 
and  such  discipline.  (176,  363,  408,  409,  4396,  f  and  g) 

Lelean  states  that  big  muscles  are  not  the  object  to  be 
sought  in  training  the  soldier.  Such  may  defeat  the  real  pur- 
pose, for  they  may  give  a  species  of  muscle-binding  fatal  to 
full  and  free  action.  What  is  needed  is  symmetry,  all  round 
development.  He  writes  that  in  the  beginning,  "The  skeletal 
muscles  are  atonic  and  the  interfibrillar  spaces  filled  with  fat. 
The  right  side  of  the  heart  is  apt  to  be  overdeveloped  or  over- 
used, causing  undue  dilation  of  the  right  auricle.  Because  of 
an  excessive  amount  of  carbon  dioxide  reaching  the  respiratory 
centers,  we  may  have  an  exaggerated  action  of  the  respiratory 
muscles.  There  may  be  an  accumulation  of  waste  products, 
excess  of  sarcolactic  acid  and  a  dicrotic  pulse."  The  objects 
of  training  are  put  by  him  as  follows : 

1.  It  should  get  the  muscles  into  shape  with  the  least  waste. 

2.  It  should  develop  the  regulation  of  blood  flow  and  pressure  properly. 

3.  It  should  bring  about  proper  respiratory  adjustment. 

4.  It  should  provide  for  the  taking  care  of  excretion. 

Hence  the  exercise  given  for  this  training  should  take  into 
consideration  the  racial  attributes  of  the  soldier,  his  present 
condition  and  physical  aptitude,  the  facilities,  the  time,  and 
the  instruction  material.  The  work  should  be  adapted  to  the 
individual,  and  not  vice  versa.  This  is  a  rather  modern  view 
in  military  circles  and  reflects  the  psychology  of  individual 
differences. 

Keefer  points  out  four  classes  of  methods  used  in  training 
the  soldier,  namely,  (i)  hygienic,  (2)  educational,  (3)  medical, 
and  (4)  military.  For  the  last,  instructional  material  should 
be  provided  for  the  following: 

[162! 


HYGIENE     AND     WAR 

1.  Setting-up  exercises  5.  Jumping  and  vaulting 

2.  Marching,  double  time,  run  6.  Applied  gymnastics,  apparatus 

3.  Rifle  and  saber  exercises  7.  Gymnastic  contests 

4.  Climbing  8.  Athletics  and  games 

9.  Swimming 

A  perusal  of  this  list  will  serve  to  indicate  that  all  of  the 
muscles  are  to  be  developed.  In  the  case  of  the  young  recruit 
it  must  be  borne  in  mind  that  the  equipment  he  carries  tends 
to  interfere  with  the  proper  movement  of  the  chest  and  vital 
organs  and  that  for  this  reason  his  muscles  should  be  gradu- 
ally accustomed  to  bear  the  strain.  For  the  older  men,  old 
muscular  habits  will  have  to  be  broken  up  and  brought  over 
to  function  in  new  ways.  The  officer  therefore  at  this  stage 
will  have  to  consider,  as  far  as  possible,  the  individual  rather 
than  the  mass.  Major  Lelean  suggests  that  the  trunk  muscles 
should  first  be  taken  care  of,  and  that  to  do  this  most  efficient- 
ly, the  maximum  daily  exercise  should  not  exceed  five  hours. 
In  the  beginning  there  should  be  no  equipment  carried  or  used. 
It  should  be  added  gradually  until  the  recruit  is  able  to  carry 
the  whole  kit.  The  back  and  loin  muscles  should  be  developed 
first. 

While  the  present  war  especially  in  the  western  regions  has 
involved  much  trench  fighting,  besieging,  etc.,  it  must  be 
borne  in  mind  that  marching  still  occupies  much  of  the  sol- 
dier's time,  much  more  than  does  combat.  This  is  clearly  seen 
in  the  Russian  campaigns.  For  this  reason  it  is  of  prime  im- 
portance that  the  soldier  be  able  to  march  well. 

The  general  public  have  a  mistaken  idea  of  the  length  of 
a  heavy  march,  the  tendency  being  to  place  the  estimate 
altogether  too  high.  A  fair  day's  marching  for  an  army  is 
12  miles.  The  strenuousness  of  the  march  depends  to  a  large 
extent  upon  the  size  of  the  marching  force.  A  good  day's 
march  consists  of  15  miles  while  20  constitutes  a  forced  march. 

Quick  time  for  the  English  armies  consists  in  about  120 
thirty-inch  steps  per  minute,  which  gives  100  yards  per  min- 
ute. From  2>^  to  3  miles  per  hour  is  good  marching.  It  takes 
a  brigade  6  hours  to  march  15  miles  while  a  division  needs 
8  for  the  same  distance. 


HYGIENE     AND     WAR 

Since  in  marching  all  the  muscles  of  the  body  are  used,  the 
training  should  be  symmetrical.  A  few  hours  of  work  in  the 
beginning  are  better  than  strenuous  efforts.  The  process  of 
hardening  should  be  gradual.  The  psychic  factors  of  course 
enter  in;  the  men,  anxious  to  make  good  soldiers,  trained  al- 
ready to  making  their  bodies  the  servants  of  their  will,  soon 
accustom  themselves  to  the  new  regime  and  become  efficient 
most  rapidly. 

Lelean  offers  the  following  practical  suggestions  (133): 

1.  March  early  in  the  day,  never  late  if  it  can  be  avoided.    Avoid  the 
heat  of  the  day. 

2.  The  speed  in  the  beginning  of  the  march  and  at  the  end  should  be 
slow. 

3.  The  troops  should  alternate  between  marching  in  step,  at  ease,  and 
with  song  and  music. 

4.  It  is  best  to  march  in  open  order,  half  the  troops  on  each  side  of  the 
road  leaving  a  space  between  them. 

5.  It  is  a  good  idea  to  leave  the  chest  bare  as  through  this  process,  espe- 
cially in  warm  weather,  the  body  temperature  is  reduced  y2  deg.  Fahr. 

6.  Halts  of  5  minutes  to  the  hour,  with  30  minutes  at  the  half  way  point, 
should  occur.    At  this  point  (half  way)  a  full  rest  should  be  taken,  equip- 
ment being  laid  aside,  the  soldier  lying  down.     When  resting  the  soldier 
should  accustom  himself  to  utter  relaxation.    The  first  halt  should  be  made 
a  short  time  after  the  start.    The  subsequent  rests  should  occur  at  intervals 
of  about  7  miles. 

7.  In   the   matter   of   conservancy   there   should   be   strict   discipline. 
Excreta  should  be  buried  with  the  trench  tools,  definite  places  having 
been  assigned  in  advance  by  officers  for  such. 

8.  Contra  indications  forbid  the  use  of  alcohol  or  smoking  while  march- 
ing. 

9.  Preceding  a  long  march  the  food  should  be  light.    After  proceeding 
about  two-thirds  of  the  way,  light  food  should  be  served.    Each  man  carries 
the  remains  of  his  last  bread  and  cheese  ration.    As  previously  suggested 
the  main  meal  should  be  served  at  the  close  of  the  march  or  in  the  evening. 
It  is  a  good  plan  to  serve  tea  at  least  at  the  conclusion  of  the  march  and 
the  full  meal  not  more  than  two  hours  later. 

10.  We  have  already  indicated  the  nature  of  cooking  requirements. 

First  Aid. — One  of  the  requirements  that  has  received  much 
emphasis  in  recent  years  is  that  of  instruction  and  practice 
in  first  aid.  Each  soldier  of  the  German  or  French  or  English 
army  is  provided  with  a  first  aid  outfit  in  the  use  of  which  they 


HYGIENE     AND     WA  R 

have  been  instructed.  In  every  case  it  is  carried  on  the  person 
whether  marching  or  in  battle.  The  results  obtained  have 
warranted  all  efforts  put  forth  in  this  line,  for  serious  infections 
have  been  avoided,  minor  ailments  tided  over  until  more  exact 
treatment  could  be  given,  and  a  spirit  of  confidence  instilled 
in  the  soldier.  Many  of  them,  before  becoming  accustomed  to 
battles,  believe  that  bleeding  to  death  is  quite  common  and 
are  in  constant  fear  of  it.  Upon  seeing  the  efficacy  of  first  aid 
rendered  their  comrades  in  the  battle  itself,  they  have  had 
their  fears  alleviated.  Such  kits  consist  for  the  most  part  of 
sterilized  bandage  and  gauze,  absorbent  cotton  treated  with 
mercury  bichloride,  in  a  water-proof  case.  (15,  76,  84,  85,  105, 
184,  267,  279,  439d) 

Swimming. — Among  the  instructions  given  to  soldiers  and 
sailors  on  transports  is  that  in  case  of  accident,  when  they  find 
themselves  in  the  water,  they  should  not  attempt  to  get  rid  of 
their  clothes,  for  in  addition  to  the  loss  of  energy  thereby, 
they  also  lose  part  of  their  buoyancy.  The  clothing  being 
filled  with  air  tends  to  keep  them  up,  and  as  it  will  take  some 
time  to  displace  this  air,  clothes  will  serve  for  some  time  as  an 
aid  rather  than  hindrance.  (407) 

THE  MEDICAL  CORPS 

History. — No  adequate  history  of  the  part  played  by  the 
medical  corps  in  any  war  has  been  published  to  date.  We 
know  that  woman,  as  an  individual,  performed  the  task  of 
taking  care  of  the  wounded  in  the  beginning.  The  burden  in 
later  times  was  undertaken  by  the  barber,  and  following  him 
the  monk.  But  the  amount  and  nature  of  the  service  rendered 
is  not  fully  known.  A  real  history  of  the  work  of  this  branch 
of  the  service  is  needed;  for  a  summing  up  of  the  achieve- 
ments of  the  medical  corps  would  prove  valuable  in  many 
ways.  Such  a  production  would  give  needed  facts — a  record 
of  heroic  deeds  unheralded  by  fame — and  also  indicate  the 
lacunae  to  be  filled.  (377,  378,  379,  380,  381) 

Organization. — The  nature  of  this  book  and  the  limitations 

[165] 


HYGIENE     AND     WAR 

of  space  prevent  anything  but  a  very  brief  discussion  of  the 
organization  of  this  corps.  It  varies  in  the  different  coun- 
tries. In  those  having  a  large  standing  army,  the  problems 
are  different  from  those  where  the  dependence  is  upon  volun- 
teer soldiers.  Yet  each  seems  to  have  worked  out  a  very  effi- 
cient system,  England  no  less  than  Germany.  The  same 
general  purposes  are  served  by  all,  though  the  methods  of 
procedure  vary.  For  details,  the  reader  is  referred  to  the 
bibliography.  Lelean's  treatment  of  this  subject  is  good.  In 
fact,  it  is  the  only  complete  one  we  have  found.  Keefer's  out- 
line or  diagram — Fig.  33,  p.  201 — is  suggestive  and  self- 
explanatory.  It  is  necessary  to  remember  that  the  organiza- 
tion involves  the  proper  care  of  those  at  home,  the  source  of 
future  soldiers,  as  well  as  those  in  battle.  (390,  391,  392) 

Sir  Wright  states  that  the  corps  must  be  organized  on  these 
lines,  (i)  Service  of  Administration;  (2)  Service  of  Hygiene 
and  Sanitation ;  and  (3)  Service  of  Treatment  of  the  Sick  and 
Wounded.  The  first  cares  for  the  wounded  on  the  battlefield 
and  for  field  hospitals,  clearing  hospitals,  conveying  wounded 
to  dressing  stations  and  thence  to  ambulance  trains,  embark- 
ing, and  finally  landing  him  in  home  hospitals;  also  for  ac- 
commodations, feeding,  bedding,  clothing,  nursing,  medical 
treatment  rendered  in  transit.  The  second  protects  from 
epidemics  by  attending  to  water,  conservancy,  anti-typhoid 
inoculation,  infectious  diseases,  carriers,  bacteriological  labora- 
tories, etc.  The  work  of  the  third  department  falls  largely 
upon  non-military  doctors.  Each  follows  his  own  methods  of 
treatment.  But  Sir  Wright  thinks  it  would  be  better  to  have 
one  general  method  of  treatment  instead.  As  in  private  prac- 
tice, it  would  be  better  to  have  each  physician  follow  the  case 
with  which  he  starts  through  its  whole  course.  (116,  133,  173, 
382,  383,  389,  390) 

Other  large  topics  which  might  engage  our  attention  are, 
ambulances,  hospitals,  field  service,  and  the  Red  Cross.  The 
literature  on  these  subjects  is  extensive.  The  bibliography  will 
indicate  sources  of  data.  (51,  87,  122,  384,  385,  386,  387,  388, 
394,  395) 

[166] 


HYGIENE     AND     WAR 

Sanitation. — Interesting  as  a  novel,  instructive  and  profit- 
able as  a  course  in  hygiene,  and  marked  by  unheralded  deeds 
of  heroism  is  the  record  of  the  achievements  of  the  medical 
corps  along  sanitary  lines.  Dr.  Lazear,  Dr.  Carroll,  Nurse 
Maas,  and  many  others  exhibited  a  grander  patriotism  and 
sublimer  courage  than  that  demanded  of  the  soldier  in  battle. 
It  is  well  to  remember  them,  for  theirs  is  a  work  of  peace,  a 
work  which  profits  all  times — even  those  of  war. 

The  Study  of  Yellow  Fever. — In  order  to  demonstrate  that 
yellow  fever  is  not  contagious,  not  taken  by  contact,  the  Reed 
board  built  a  small,  almost  air-tight  house,  with  very  little  ven- 
tilation, screened  windows,  and  double  screened  doors.  In  this 
were  placed  mattresses,  bed  clothing,  and  pajamas  oL  the 
patients  from  the  Las  Animas  Yellow  Fever  Hospitals.  In 
addition,  basins  of  black  vomit  and  excreta  from  the  yellow 
fever  patients  were  poured  on  them  so  that  every  possible 
chance  for  contact  infection  might  be  offered.  Volunteers 
were  called  to  sleep  in  this  house,  dressed  in  these  pajamas, 
and  on  these  mattresses.  No  trumpets  beat — no  legions  hur- 
rahed— no  flags  waved.  But  Dr.  R.  P.  Cook  and  several  sol- 
diers came  forward  and  spent  twenty  nights  under  these  con- 
ditions. Thus  was  demonstrated  that  yellow  fever  is  neither 
a  contact  nor  a  filth  disease. 

The  organization,  system,  discipline,  etc.,  of  the  army  make 
it  possible  to  carry  sanitary  measures  into  effect.  By  such 
means,  with  the  hearty  cooperation  of  her  citizens,  was  San 
Francisco  saved  from  plague.  (115)  Thus  was  New  Orleans, 
after  being  frightfully  exposed  by  vacillating  officials,  finally 
rescued.  (418) 

Cholera. — The  achievements  of  Great  Britain  in  fighting 
cholera  in  India  were  possible  through  her  military  organiza- 
tion. Upon  our  advent  in  the  Philippines,  it  was  possible  to 
use  our  military  forces  in  cleansing  the  cities.  Malta  fever, 
dysentery,  and  cholera  were  thus  brought  under  control.  Find- 
ing that  Porto  Ricans  were  suffering  from  anaemia — our  forces 
were  able  to  fight  a  successful  campaign  against  the  parasite 
causing  the  suffering.  Cuba,  Porto  Rico,  and  Panama  suffered 


HYGIENE     AND     WAR 

much  from  malaria  and  yellow  fever,  but  through  the  long, 
arduous  investigations  and  discoveries  of  military  sanitarians 
and  the  faithful  execution  of  their  suggestions,  the  tropics 
have  again  become  habitable  to  men  of  the  temperate  zones. 

"There  has  been  a  great  deal  of  discussion  as  to  who  de- 
serves the  credit  for  this  great  discovery  of  the  mode  of  trans- 
mission of  yellow  fever.  Undoubtedly  Reed  and  his  board 
brought  all  the  threads  together  and  actually  made  the  great 
discovery,*  but  Finlay,  Sternberg,  Carter,  and  others  started 
the  spinning  of  many  of  these  threads.  Like  all  great  dis- 
coveries everywhere,  it  was  gradually  led  up  to  by  many 
workers. 

Nothing  is  more  true  than  the  following  quotation  from 
Huber's  papers:  (72,  pp.  75-76) 

And  let  me  premise  here  that,  in  science  at  least,  great  names  are  land- 
marks; and  the  owners  of  these  names  have  traversed  and  gleaned  in  fields 
where  many  a  devoted  laborer  had  delved  and  sown,  and  practically 
sweated  blood  in  his  altruistic  zeal.  In  science  at  least  no  man  works  in 
vain.  Full  many  an  one,  worthy  of  an  elegy,  has  given  his  whole  life  to 
establishing  a  fact,  or  indeed  only  an  item  to  a  fact;  his  work  unrealized, 
ridicule  and  even  persecution  ofttimes  his  only  compensation,  throughout 
perhaps  in  the  meanest  destitution;  yet  his  life  and  his  work  have  been 
absolutely  essential  to  the  building  of  a  mighty  fabric.  Martyrs  have  been 
many  among  such — dying  from  the  diseases  from  which  they  sought  to 
defend  others;  knowing,  too,  full  well  what  their  own  fate  would  be.  Nor 
does  it  in  any  wise  detract  from  the  gratitude  due  the  great  man  that  he  has 
profited  by  the  labors  of  others,  adding  what  he  can  of  his  own,  scrutinizing 
every  detail,  every  datum,  permeating  and  illuminating  with  his  own  genius, 
cementing  the  mass  with  his  own  deductions. 

And  from  Flexner: 

Remarkable  achievements  are  never  unique  occurrences  in  nature. 
Even  the  greatest  men  rest  on  the  shoulders  of  a  multitude  of  smaller 
ones  who  have  preceded  them;  and  epochal  discoveries  emerge  out  of  the 
periods  of  intellectual  restlessness  that  affect  many  minds. 

Panama  Canal  Made  Possible. — Indicative  of  the  accom- 
plishments of  proper  hygiene  and  sanitation,  carried  on  under 
a  military  routine,  we  present  the  following  from  Colonel 
Gorgas'  'Sanitation  in  Panama' : 

[168] 


HYGIENE     AND     WAR 

Now  let  us  consider  the  totals:  we  had  an  average  of  900  men  sick  every 
day.  For  the  year,  this  would  give  us  328,500  days  of  sickness,  and  for  the 
10  years  3,285,000  days  of  sickness.  If  our  rate  had  been  300  per  1,000,  a 
very  moderate  figure  compared  with  what  it  was  under  the  French,  we 
should  have  had  1 1 ,700  sick  every  day.  For  the  year  this  would  have  given 
us  4,270,500  days  of  sickness  and  for  the  ten  years,  42,705,000,  a  saving  of 
39,420,000  days  of  sickness  during  this  period.  This  saving  must  justly 
be  credited  to  sanitation! 

It  cost  us  about  one  dollar  a  day  to  care  for  a  sick  man  on  the  Isthmus. 
The  Commission  cared  for  the  sick  free  of  charge.  Every  day,  therefore,  of 
sickness  prevented  on  the  Isthmus  lessened  the  expense  which  the  Com- 
mission had  to  bear  by  one  dollar.  The  Commission  was  therefore  saved 
by  this  sanitary  work,  if  we  consider  the  whole  ten  years  of  construction, 
$39,420,000. 

This  represents  only  one  phase  of  the  saving  due  to  sanitation,  merely 
the  saving  due  to  decrease  in  the  numbers  of  sick  who  had  to  be  cared  for. 
But  the  sanitary  work  really  saved  much  more  than  this.  If  three  hundred 
men  out  of  every  thousand  of  our  employees  had  been  sick  every  day,  the 
efficiency  of  the  other  seven  hundred  would  have  been  correspondingly 
decreased.  The  other  seven  hundred  would  have  been  more  or  less  debili- 
tated and  more  or  less  depressed,  and  the  amount  of  work  turned  out  daily 
by  each  man  would  have  been  considerably  less  than  it  actually  was  for  the 
employee  enjoying  good  health  and  cheerful  surroundings.  We  should 
have  had  to  pay  considerably  higher  wages,  if  the  Isthmus  had  continued 
to  bear  the  reputation  during  our  period  of  construction  which  it  had 
always  borne  during  the  years  preceding  1904;  if,  for  instance,  it  had  been 
known  that  three  out  of  every  ten  men  going  to  work  on  the  canal  would 
be  sick  all  the  time,  that  two  out  of  every  ten  would  die  each  year,  and  that 
the  whole  ten  would  be  dead  at  the  end  of  five  years. 

Great  loss  was  caused  to  us  in  the  first  years  on  the  Isthmus  by  the 
demoralization  among  the  working  force,  and  almost  stoppage  of  work 
which  took  place  during  periods  of  exacerbation  in  the  yellow  fever  con- 
dition, or  when  prominent  employees  died  of  that  disease. 

Considering  all  these  factors,  it  will  not  be  considered  an  exaggerated 
estimate  to  state  that  eighty  million  dollars  was  saved  by  the  United 
States  Government  by  the  sanitary  work  done  on  the  Isthmus  during  the 
ten  years  of  construction.  . 

During  the  ten  years  of  construction,  we  lost  by  death  seventeen  out  of 
every  thousand  of  our  employees  each  year.  That  is,  from  the  whole 
force  of  39,000  men,  663  died  each  year,  and  for  the  whole  construction 
period  we  lost  6,630  men.  If  sanitary  conditions  had  remained  as  they 
had  been  previous  to  1904  and  we  had  lost,  as  did  the  French,  two  hun- 
dred of  our  employees  out  of  each  one  thousand  on  the  work,  we  should 
have  lost  7,800  men  each  year  and  78,000  during  the  whole  construction 
period. 

[169] 


HYGIENE     AND     WAR 

We  therefore  claim  for  the  work  of  the  Sanitary  Department  the  saving 
of  71,370  human  lives  during  the  building  of  the  Panama  Canal.  Where 
one  man  died  probably  three  would  have  returned  home  broken  in  health, 
with  months  and  years  of  suffering  and  invalidism  ahead  of  them.  Sani- 
tation of  the  Isthmus  has  saved  this  heavy  toll  to  the  devoted  people 
engaged  in  this  great  work,  and  was  therefore  a  most  wise  and  lucrative 
investment  to  our  Government,  and  played  a  most  important  part  in 
aiding  the  construction  work  in  that  great  enterprise. 

Gorgas  rightly  considers  that  greater  than  the  contribution 
already  pointed  out  is  the  demonstration  that  tropical  regions 
can  be  safely  inhabited  and  hence  developed  by  men  of  the 
temperate  zones. 

Barracks  and  Camp. — In  the  selection  of  the  site  for  these, 
strange  as  it  may  seem  to  some,  the  same  factors  are  considered 
as  in  locating  a  public  building  such  as  college  or  school. 
While  the  exigencies  of  war  prevent  a  literal  fulfillment  of 
these  conditions,  efforts  are  made  to  meet  them.  These  fac- 
tors are  (i)  Surroundings,  (2)  Aspect  and  Elevation:  one 
writer  has  well  said,  "Where  the  sun  never  goes,  there  the 
doctor  must  go."  For  this  reason  it  is  essential  that  provision 
be  made  for  proper  sun,  wind,  weather  exposure.  The  direc- 
tion of  the  prevailing  winds  is  considered  in  the  location  of 
barracks  or  camp,  temporary  as  well  as  permanent.  Woodhull 
suggests  that  a  screen  of  woods  should  be  kept  between  enemy 
and  camp  if  possible.  (3)  Drainage — As  the  refuse  from  the 
kitchens,  men,  and  beasts  will  be  concentrated  within  a  rela- 
tively small  space,  this  is  especially  important.  Closely  re- 
lated to  drainage  is  (4)  the  Nature  of  the  Soil  and  Subsoil.  A 
fulfillment  of  necessary  conditions  along  these  lines  will  les- 
sen the  time  and  trouble  needed  to  get  rid  of  fleas,  roaches, 
mosquitoes,  etc.  Dense  vegetation  tends  to  keep  fog  close  to 
the  earth.  For  this  reason  it  is  well  to  clear  away  tall  grass, 
etc.  (116,  133,  259) 

Barracks  should  be  constructed  of  such  material  and  in  such 
a  manner  as  to  be  dry,  warm,  well  lighted  and  ventilated,  and 
rat-proof.  Keefer  advises  that  for  each  man  in  the  squad 
room,  there  should  be  60  sq.  ft.  of  floor  space  and  600  cu.  ft. 
of  air  space.  This  is  the  minimum;  60  sq.  ft.  of  floor  space 


HYGIENE     AND     WAR 

with  800  cu.  ft.  of  air  space  are  better.  Woodhull  suggests 
the  following:  50  sq.  ft.  floor  space  and  600  cu.  ft.  air  space; 
south  of  latitude  36°  North,  70  sq.  ft.  and  800;  in  India  from 
75  to  150  sq.  ft.  and  from  1,500  to  3,000  cu.  ft.  In  a  room 
15  ft.  wide  one  man  should  be  allowed  to  each  yard  of  length; 
from  15  to  25  ft.,  2  men  per  yd.,  and  where  more  than  25  feet 
wide  3  men  per  yd.  of  length.  There  should  be  3,000  cu.  ft.  of 
fresh  air  per  hour  for  each  man,  which  means  that  a  space  of 
100  cu.  ft.  must  be  changed  30  times  per  hour.  The  room 
should  be  from  12  to  14  ft.  high  and  not  wider  than  24  ft. 

The  bunks  should  be  at  least  one  foot  from  the  wall  and 
should  be  kept  clean.  The  tendency  to  throw  dirty  clothes 
under  them  and  also  under  the  pillows  (seen  in  summer  camps 
for  boys  and  girls  also)  should  be  eradicated.  Beds  and  bed- 
ding should  be  kept  clean  and  aired  often,  at  least  once  per 
week.  The  same  is  true  for  tents. 

It  is  unwise  to  flush  the  floors  with  water  for  the  purpose  of 
cleansing  them.  Dry  cleaning  is  more  hygienic.  Care  must 
therefore  be  exercised  in  their  construction  and  composition. 

Everything  and  every  person  connected  with  the  mess 
should  be  kept  clean.  Cooks  should  bathe  daily  and  dress  in 
clean  clothes  daily  if  possible.  One  author  recommends  white 
for  this  purpose. 

Camp  and  Battlefield  Sanitation.- — In  halts  in  marching  and 
in  the  establishment  of  camps,  one  of  the  primary  measures 
is  to  establish  latrines,  etc.  That  these  shall  be  used  properly 
it  is  necessary  to  have  special  sentinels  over  them  and  to 
punish  abuses  severely.  These  latrines  should  be  easy  of 
access  but  at  least  100  feet  from  the  cooking  quarters.  (155) 

Lelean  states  that  of  the  total  average  amount  of  feces 
passed  per  person  daily,  3  oz.  is  water  and  5  oz.  urine.  With  a 
body  of  troops  this  totals  such  an  amount  that  it  is  imprac- 
ticable to  evaporate  it.  Hence,  some  other  way  has  to  be  pro- 
vided. He  states  that  it  has  been  found  that  66%  of  the 
weight  of  the  urine  in  sawdust  will  permit  evaporating  it  by 
burning.  For  a  regiment  of  1,000  men  about  100  Ibs.  thus 
used  is  efficient.  A  horse  requires  the  equivalent  of  four  men 

[171] 


HYGIENE     AND     WAR 

in  the  incineration  of  its  feces.  From  this  it  is  seen  that  it  is 
necessary  to  keep  liquid  and  solid  waste  separate.  Separate 
receptacles  should  be  provided  for  the  dry  and  fluid  waste  of 
kitchen  and  camp.  Our  discussion  of  our  army  in  Vera  Cruz 
has  already  showa  how  latrines  and  drainage  may  be  taken 
care  of.  For  further  data  along  this  line,  the  reader  is  referred 
to  Keefer  (ch.  XII)  and  Lelean  (Lecture  VII). 

WATER  SUPPLY 

It  is  pointed  out  by  one  writer  that  moving  troops  are  not, 
as  a  general  thing,  bothered  so  much  with  enteric  as  stationary 
troops.  This  he  attributes  to  their  own  excretions  which  the 
latter  neglect  to  take  care  of  through  cleanliness,  and  to 
neglect  of  water  supply,  and  of  control  and  elimination  of 
flies,  mosquitoes,  lice,  etc.  (422,  423,  425,  426,  427) 

Selection  and  Protection. — The  importance  of  water  in  cura- 
tive and  preventive  medicine  in  connection  with  food, 
cleanliness,  and  regulation  of  body  temperature,  needs  no 
further  emphasis  here.  In  the  selection  of  a  camp,  too,  it  is 
carefully  considered.  (133,  ch.  VIII)  Through  a  proper  con- 
sideration of  (i)  disposal  of  garbage  and  refuse;  (2)  provision 
of  suitable  water  supplies  and  prevention  of  their  contamina- 
tion; (3)  drainage  and  conservancy,  and  (4)  control  of  infec- 
tious diseases  and  disinfection,  only  10  cases  of  typhoid  oc- 
curred in  a  body  of  600,000  troops,  from  the  beginning  of  the 
war  up  to  Oct.  loth,  1914.  (88,  116,  ch.  VIII) 

Major  Lelean  offers  the  following  data  on  the  water  supply : 

AMOUNT   NEEDED  Daily 

a.  Each  man  should  have,  in  barracks    ....  20  gals. 

Each  man  should  have,  in  standing  camp  where  clothes 

are  washed     ....  5  gals. 

Each  man  should  have,  in  camp  where  no  clothes  are 

washed  ....  3  gals. 

Each  man  should  have,  in   bivouacs   for  drinking  and 

cooking  only  ...  I  gal. 

Each  man  should  have,  for  drinking  only  a  minimum  of  3  pints 

[172] 


HYGIENE     AND     WAR 

b.  Daily  requirements  for  animals 

Each  horse  or  camel  ....  .10  gals. 

Each  ox   .........  8  gals. 

Each  mule        ........  6  gals. 

Each  donkey    .         .         .          .         .  .         .  5  gals. 

Each  sheep  or  pig      .......  2  gals. 

The  same  factors  enter  into  the  selection  of  water  as  those 
involved  in  corresponding  municipal  problems, — source,  dan- 
gers of  contamination,  etc.  But  greater  efforts  have  to  be 
expended  in  purification  since  prevention  is  not  so  easy  under 
war  conditions. 

Purification. — The  following  methods  of  purification  are  sug- 
gested by  Keefer: 

A.  Sedimentation.  B.  Precipitation  (as  through  use  of  alum).  C.  Filtra- 
tion, (ist.  Through  a  3-foot  layer  of  sand ;  2nd.  Through  a  mechanical  filter 
in  connection  with  alum,  or  iron  with  lime.)  D.  By  use  of  copper  sulfate. 
E.  By  use  of  chlorine  gas.  F.  By  use  of  ozone.  G.  By  means  of  ultra- 
violet rays. 

Boiling  the  water  is  the  surest  means  of  killing  all  germs. 
Various  devices  are  being  used  by  the  various  armies  in  the 
present  war.  In  some  cases  their  construction  has  not  been 
made  known  to  the  general  public.  Some  have  been  used 
hitherto  and  described. 

Enteric  germs  will  pass  through  a  very  thick  layer  of  sand 
(15  ft.)  Lelean  reports.  Hence  this  is  not  a  good  means  of 
filtration.  As  bacteria  are  protected  from  ultra-violet  rays  by 
organic  matter  held  in  suspension  in  water,  this  means  can  be 
employed  only  when  the  water  is  clear. 

Clarification  by  precipitation  may  be  brought  about  by 
adding  5  grains  of  alum  and  \]/z  of  sodium  bicarbonate  to 
the  gallon  of  water.  Or  add  one  teaspoonful  of  alum  to  100 
gallons  of  water,  letting  it  stand  until  settled,  when  the  clear 
water  should  be  siphoned  off.  If  it  is  disturbed,  the  process 
will  be  reversed. 

Thresh  suggests  the  sterilization  of  potable  water  by  adding 
I  part  chlorine  to  1,000,000  water  or  from  I  to  2  parts  if  the 
water  is  foul.  The  troops  should  carry  with  them: 

[173] 


HYGIENE     AND     WAR 

1.  A  high  quality  of  chlorinated  lime  in  K"  Ib.  cans,  hermetically  sealed. 

2.  A    corresponding    number    of    ^  Ib.    packets    sodium    thiosulfate 
(hyposulfate  combined  with  chlorine). 

3.  Add  one  can  of  No.  i  to  one  gal.  of  water  and  shake  well. 

4.  Add  one  packet  of  No.  2  to  one  gal.  of  water  and  shake  till  dissolved, 
(i  gal.  of  No.  3  will  sterilize  8,000  gals,  ordinary  clear  river  or  well  water  in 
15  minutes.) 

5.  Add  No.  4  to  No.  3  (this  will  eliminate  excess  chlorine). 

6.  One  fluid  ounce  of  No.  5  to  50  gals,  of  water  is  sufficient  (232). 

ALCOHOL,  TOBACCO,  AND  OTHER  NARCOTICS 

Is  alcohol  a  food?  Shall  the  soldier  and  sailor  use  it?  If  so, 
how  and  to  what  extent?  These  are  questions  that  have  en- 
gaged the  attention  of  the  military  as  well  as  lay  medical  men 
for  ages  and  the  data  are  about  the  same  from  each  source. 
We  are  not  able  to  give  specific  answers  to  some  of  these 
questions,  for  the  problem  is  a  complex  one  and  positive  state- 
ments are  not  in  order  at  this  stage.  However,  such  data  as 
military  men  have  obtained  seem  to  indicate  the  limitation  of 
the  use  of  alcohol  and  alcoholic  beverages  to  that  of  a  medicine 
given  only  under  the  direction  of  a  physician.  Large  amounts 
all  agree  are  extremely  injurious.  It  affects  the  character, 
health,  and  conduct  of  the  victim,  making  discipline  hard  for 
the  officers,  increasing  the  burdens  of  an  overtaxed  medical 
corps,  and  reducing  the  fighting  efficiency  of  the  army.  (116, 
133,  259,  268,  363  n  and  p) 

Russia,  whose  revenue  has  been  derived  largely  from  this 
source,  has  limited  its  sale  and  use  to  a  great  extent  in  even 
this,  her  time  of  dire  need.  Germany  forbade  the  use  of  alco- 
hol among  troops  at  the  time  of  mobilization.  Practically 
every  nation  in  the  war  has  made  some  national  prohibition 
with  reference  to  its  use.  A  nation-wide  campaign  has  been 
made  in  England  against  alcohol,  and  strenuous  advocates  even 
urged  the  government  to  control  forcibly,  perhaps  to  stop,  the 
sale  of  it.  (269,  270,  272,  273) 

Naturally,  much  exaggeration  abounds  at  such  times,  and 
reports  without  statistical  basis  should  be  accepted  with  hesi- 
tation— and  then  only  in  general  when  the  character  and 

[174] 


HYGIENE     AND     WAR 

source  of  the  statistics  are  known.  For  example,  an  English 
writer  claims  there  is  a  '  'regrettable  amount  of  intoxication" 
among  the  wives  and  dependents  of  the  soldiers  at  the  front 
and  among  the  soldiers  in  training  at  home.  He  suggests,  as 
the  remedy,  compelling  the  public  houses  (saloons)  to  open 
later,  about  mid-day,  and  to  close  earlier,  about  8  or  9  p.  m. 
The  cause  of  this  excessive  use  varies  with  different  classes — 
the  women  of  the  better-off  classes  have  a  larger  allowance 
which  is  spent  for  substitutes,  for  something  better, — the 
women  of  the  poorer  classes  have  been  thrown  out  of  work,  are 
idle,  and  drink  to  fill  their  time.  "  Recruits  are  being  trained 
in  large  masses  in  locations  where  the  opportunities  for  healthy 
recreation  after  violent  and  sustained  exertion  are  few."  The 
natural  inference  is  that  legitimate  amusements,  sports,  and 
games  should  be  provided.  The  civilian's  habit  of  treating 
soldiers,  and  the  soldiers'  of  treating  each  other,  has  proven  as 
pernicious  as  treating  always  has  among  civilians.  Lord 
Roberts  made  an  earnest  appeal  to  the  people  of  Great  Britain 
to  avoid  this. 

Not  the  soldiers  only  are  affected  by  drinking  and  drunken- 
ness for  it  has  been  found  that  these  habits  interfere  with  those 
civilians  engaged  in  the  manufacture  of  the  sinews  of  war, 
munitions,  ship-building,  transport  industry.  In  England 
there  exists,  as  in  other  European  countries,  a  sort  of  tradition 
that  drinking  is  an  aid  to  industrial  efforts.  This  has  to  be 
combatted.  The  fine,  healthy  specimens  of  manhood — the 
type  of  men  who  are  temperate,  who  can  control  their  appe- 
tites— have  been  called  away,  and  thus  the  weaklings,  the  less 
efficient,  are  left  at  home.  It  is  therefore  all  the  more  neces- 
sary to  control  the  liquor  business  at  home.  Lack  of  muni- 
tions, etc.,  may  prove  as  disastrous  as  lack  of  men,  as  was 
evidenced  in  the  action  of  Teutons  against  the  Russians  in 
the  summer  of  1915.  The  factors  mentioned  may  account  for 
the  temporary  increase  in  the  proportionate  amount  of  alcohol 
used  by  those  at  home.  Liberal  wages  permit  of  convivial 
excesses.  It  might,  suggests  one  writer,  be  well  to  have  pro- 
hibition of  distilled  spirits  (in  England).  After  a  conference  it 

[175] 


HYGIENE     AND     WAR 

was  urged  that  every  one  in  England  abstain  from  alcohol 
during  the  war,  that  efforts  be  made  to  provide  all  with  neces- 
sary food,  raiment,  etc.,  and  that  proper  recreation  be  fur- 
nished for  the  soldiers. 

Dr.  H.  Lyon  Smith  points  out  that  some  claim  that  alcohol 
inhibits  phagocytosis.  He  found  this  to  be  true  where  large 
doses  were  given  (10  oz.  for  adult)  but  that  small  doses  (2  oz.) 
distinctly  increased  phagocytic  action  upon  common  patho- 
genic bacteria  (pneumococci,  bacilli  coli,  streptococci,  bacilli, 
influenza).  With  a  number  of  patients  in  whom  anaphylaxis 
occurred,  he  found  those  treated  with  alcohol  had  either 
neutralized  the  poison,  stimulated  the  development  of  anti- 
toxin, or  narcotized  the  nervous  system  for  the  time  being. 
Therefore  in  the  first  stages  of  disease,  the  moderate  use  of 
alcohol  will  aid  in  the  neutral  resistance  of  the  body  to  these 
germs.  After  the  patient  is  thoroughly  infected,  it  is  of 
no  use  to  administer  alcohol.  He  recommends  its  use  as  a 
drug  in  amounts  of  about  i^?  oz.  daily.  (233) 

Sir  Victor  Horsley,  who  has  done  much  work  on  this  subject, 
objects  to  the  recent  re-introduction  of  the  old  English  army 
rum  ration.  (Jan.  1915.)  The  results,  he  claims,  of  such  a 
ration  are:  (i)  decadence  of  morale  causing  carousing,  friction, 
disorder;  (2)  drunkenness;  (3)  decadence  of  observation  and 
judgment,  giving  rise  to  more  errors  and  accidents;  (4)  loss 
of  endurance  and  diminution  of  physical  vigor;  (5)  loss  of 
resistance  to  cold ;  (6)  loss  of  resistance  to  diseases,  especially 
those  due  to  cold,  as  pneumonia,  dysentery,  typhoid;  (7)  loss 
of  efficiency  in  shooting.  ("Held  rum  ration  causes  a  loss  of 
40  to  50  per  cent,  in  rifle  shooting.  The  naval  rum  ration 
causes  a  loss  of  30  per  cent,  in  gunnery  shooting.")  (95,  96) 

Professor  Parkes  asserts  that  alcohol  is  not  a  perfectly 
reliable  aid.  One  should  have  a  knowledge  of  its  full  action 
before  prescribing.  It  has  been  observed  that  the  immediate 
effect  of  one  fluid  ounce  of  absolute  alcohol  is  reviving  but 
transient.  After  2  to  2.^/2  miles  of  marching  and  often  before, 
there  is  a  relapse.  Its  anaesthetic  and  narcotic  effects  then 
become  more  marked.  Subsequent  use  gives  a  diminishing 


HYGIENE     AND     WAR 

return  even  in  the  way  of  apparent  revival.  In  cases  of  ex- 
treme fatigue,  where  the  heart  needs  it,  the  physician  may  pre- 
scribe it.  He  states  that  meat  extract  and  coffee  are  better, 
as  they  really  give  strength.  Some  of  the  facts  gathered  from 
actual  observation  of  troops  under  more  or  less  controlled 
conditions  are: 

1.  Entire  abstinence  from  alcohol  did  not  make  men  more  sickly  as  a 
whole  or  more  disposed  to  malarial  fever. 

2.  The  marching  powers  of  teetotalers  were  good.   . 

3.  The  reviving  effects  of  the  rum  when  given  at  the  end  of  the  day  were 
strongly  (spoken  of!)     Under  exhaustion  after  great  exertion,  alcohol  will 
quicken  the  heart  and  act  for  a  time  as  a  restorative,  though  it  may  be 
hurtful  or  not  useful  during  the  actual  period  of  exertion.     The  general 
feeling  of  warmth  caused  by  alcohol  and  the  temporary  strengthening  of 
the  heart's  action  were  also  no  doubt  succeeded  by  a  slight  anaesthetic 
effect,  making  the  sleep  rather  more  profound. 

4.  The  evidence  of  one  or  two  of  the  men  is  that  they  marched  better 
when  rum  had  been  issued  on  the  previous  evening. 

5.  Some  of  the  evidence  indicated  the  greater  power  of  digestion  given 
by  the  rum  and  the  increased  appetite  given  by  somewhat  changing  the 
monotony  of  the  food. 

Alcohol,  he  states,  is  like  a  bill  of  credit  which  merely  gives 
a  man  time  to  summon  and  marshal  his  reserve — he  must 
have  a  reserve.  From  his  long  study  of  the  subject,  he  sug- 
gests the  use  of  alcohol  only  as  a  drug  given  under  the  physi- 
cian's direction.  (175,  176) 

In  his  chapter  on  alcohol  and  other  narcotics,  Keefer  has 
given  data  bearing  on  the  use  of  alcohol.  He  describes  the 
experiment  performed  in  Sweden  where  40  per  cent,  fewer  hits 
were  made  after  a  drink  of  brandy  had  been  taken.  (116) 

Lelean  gives  the  following  facts:  About  2  oz.  of  alcohol  can 
be  oxidized  daily.  There  is  from  1^4  to  2^  oz.  of  alcohol  in 
the  rum  ration.  On  men  accustomed  to  anticipating  the  grog 
at  the  end  of  the  march,  it  has  a  psychic  effect,  perhaps  lending 
zest  to  the  closing  work  of  the  day.  Alcohol's  first  effect  is  to 
stimulate  the  heart.  It  dilates  the  capillaries,  aids  digestion, 
and  produces  a  comforting  cutaneous  sensation  of  warmth. 
Later  it  has  a  mild  hypnotic  effect.  The  dilation  of  the  surface 

[177] 


HYGIENE     AND     WAR 

blood  vessels  leads  to  an  eventual  loss  of  heat.  The  physio- 
logical resistance  is  lowered.  Some  animals  normally  immune 
to  a  disease  will  take  it  upon  the  injection  of  alcohol.  (133) 

Of  the  objections  that  may  be  offered  to  its  use,  he  gives: 
the  caloric  value  can  be  supplied  better  by  cocoa,  etc.,  which 
repair  tissue  as  well  as  give  energy — soup  also  is  good  for  it 
stimulates  digestion ;  the  heat  loss  from  alcohol  is  too  great;  its 
effect  upon  discipline  is  bad. 

It  should  be  issued  only  under  the  following  conditions: 
only  when  there  is  no  suitable  alternative;  only  in  special 
amounts  after  the  day's  work  is  done,  and  with  the  main  meal 
just  before  turning  in  for  sleep.  Commerce  in  rum  should  be 
made  unlawful  except  for  those  authorized.  The  buyer  and 
seller  should  both  be  punished. 

There  are  no  such  strenuous  objections  to  tobacco.  While 
it  certainly  confers  no  positive  benefits,  the  degree  of  injury  is 
small,  perhaps  counterbalanced  by  its  psychic  effects.  Lelean 
points  out  that  it  has  a  tachycardiac  effect,  that  it  tends  to 
muscular  relaxation  and  to  a  diminution  of  visual  acuity.  He 
would  limit  the  amount  used  to  two  pipefuls  per  day  and  pro- 
hibit cigarettes.  (428) 

Some  Inferences  from  Data. — German  writers,  teachers,  and 
military  men  are  urging  upon  the  general  public,  and  the 
teachers  especially,  that  this  is  a  most  opportune  time  to 
impress  upon  the  youth  of  the  land  the  necessity  of  practising 
hygiene  at  all  times.  Now  when  the  fatherland  needs  the 
best,  when  men  are  doing  in  the  field,  in  the  trenches,  the 
things  which  it  is  desirable  that  children  and  grown  folk  do  at 
home,  it  is  quite  easy  to  influence  the  youth  in  the  formation 
of  correct  habits  along  these  lines.  That  each  may  render  to 
the  state  the  best  that  is  within  him,  he  must  be  of  sound  body 
and  mind.  This  means  that  he  must  eat,  drink,  exercise, 
dress,  think,  and  sleep  properly.  He  has  the  examples  about 
him  in  the  men  who  are  giving  their  all  for  their  native  land. 
No  longer  is  the  use  of  alcohol  a  mere  theme  of  agitation  for 
cranks.  It  is  vital  to  the  state  to  regulate  it  to  the  extreme 
and  even  prohibit  its  use  in  places.  These  facts  properly 


HYGIENE     AND     WAR 

placed  before  the  pupils  are  much  more  convincing  than  moral 
discussions  and  typical  temperance  lectures.  This  will  require 
real  study  of  the  problems  involved,  on  the  part  of  teachers. 
And  that  their  instruction  may  have  maximum  influence  they 
should  practise  what  they  preach.  The  leaflets  bearing  on 
food,  clothing,  exercise,  treatment  of  wounds  and  disease  will 
prove  better  texts  and  be  better  learned  than  the  usual  books 
on  physiology,  etc.  Let  the  boys  and  girls  at  home  plan  and 
take  part  where  possible  in  keeping  the  home  and  city  condi- 
tions hygienic.  Let  them  distribute  literature  and,  better  yet, 
let  them  form  clubs  such  as  Boy  Scouts  which  train  along  such 
lines.  They  may  thus  come  to  feel  that  they  too  are  shoulder- 
ing their  part  of  the  responsibility  for  the  welfare  of  the  father- 
land. 

While  these  injunctions  are  particularly  apropos  for  the 
nations  at  war,  it  certainly  would  seem  that  the  opportunity 
for  their  most  efficient  functioning  is  in  times  of  peace.  The 
real  preparedness  for  the  struggle  of  life,  whether  it  be  war  or 
peace,  public  or  private,  is  made  through  the  formation  of 
correct  habits  of  conduct  during  the  plastic  years.  If  instruc- 
tion really  functions,  it  would  seem  that  the  logical  conclusion 
for  pedagogy  is  that  a  large  part  of  all  our  instruction  should 
at  all  times  be  given  under  the  same  principle,  namely,  the 
actual  training  through  action  under  conditions  correlated 
with  the  home  and  civic  environment  of  the  child.  (358) 


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60.  FASTREZ,  ARTHUR.    Ceque  1'armee  peut  pour  la  nation,  par  le  lieute- 

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64.  FORTESQUE,  R.    The  value  of  medical  baths  for  invalid  soldiers.    Pro~ 

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65.  FOULERTON,  ALEXANDER,  G.  R.    Some  elementary  principles  in  the 

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66.  FURSE,  GEORGE  ARMAND.    Provisioning  armies  in  the  field.    London, 

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69.  GOLDBERG,   J.     Yellow  fever;    etiology,   symptoms  and   diagnosis. 

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71.  GORDAN,  W.  H.     Traumatic  tetanus.     Lancet,  London,  1914,  v.  2, 

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73.  GRAHAM,  H.  E.    Garbage  disposal.     Lancet,  London,   1914,  v.  2, 

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75.  GROFF,  G.  G.    Vaccinating  a  nation.    New  York,  Medical  News,  1899, 

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76.  GROSS,  S.  D.    Manual  of  military  surgery  or  hints  on  emergencies  of 

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77.  GROVES,  E.  W.  H.     Some  problems  of  gunshot  fracture.     Lancet, 

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78.  GUTHRIE,  G.  J.    Commentaries  on  surgery  of  war  in  Portugal,  Spain, 

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79.  GUY,  WM.    A  popular  introduction  to  sanitary  science,  Part  II;  war 

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80.  HABERLING,  W.    Das  Dimenwesen  der  Heeren  und  seine  Bekampfung: 

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90.  HOFF,  J.  VAN  R.    Report  from  Manchuria.    United  States  War  De- 

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91.  HOFF,  J.  VAN  R.    Military  hygiene  and  how  the  people  of  the  United 

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92.  HOFFMAN,  W.,  and  SCHWIENING,  H.     Hygiene  der  militarischen  Un- 

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93.  HORNE,  Dr.  JOBSON.    Gun-deafness  and  its  prevention.    Lancet,  Lon- 

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94.  HORNER,  G.  R.  B.     Disease  and  injuries  of  seamen.     Enlistment. 

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95.  HORSLEY,  Sir  VICTOR.     The  Army  Rum  Ration.     British  Medical 

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96.  HORSLEY,  Sir  VICTOR,  and  STURGE,  M.  D.    Alcohol  and  the  human 

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97.  HOUSTON,  A.  C.    Studies  in  water  supply.     New  York,  Macmillan, 

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98.  HOWARD,  L.  O.    Some  facts  about  malaria.    U.  S.  Department  of  Ag- 

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99.  HOWARD,  W.  L.    War  as  a  home  maker.    Medical  Times,  New  York, 

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100.  HUBER,  J.  B.    Bullets  and  germs.  Harper's  Weekly,  New  York,  1914, 

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103.  IEVERS,  P.  G.    Sanitary  notes  for  recruits;   intoxicating  liquors;   to- 

bacco and  its  injurious  effects.  Journal  of  the  Royal  Army  Medi- 
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104.  IOTEKI,  I.    Entrainement  et  fatigue  au  point  de  vue  militaire.    Brux- 

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105.  JACOBI,  Dr.  C.     Fatigue  and  exhaustion.     Munchener  medizinische 

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106.  JEFFREYS,  J.     The  British  Army  in   India.     Its  preservation  by 

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107.  JENKINS,  L.  T.    The  duties  of  medical  officers  on  the  march.    Boston, 

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108.  JOHNSON,  C.  WEBB.     Soldiers'  feet  and  footgear.     British  Medical 

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109.  JONES,  HERBERT.  The  public  service  and  the  national  crisis.  Public 
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112.  JORDAN,  DAVID  STARR.    The  human  harvest.    Boston,  American  Uni- 

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113.  JORDAN,  DAVID  STARR.    The  unseen  empire.    Boston,  American  Uni- 

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114.  JORDAN,  DAVID  STARR  and  JORDAN,  H.  E.    War's  aftermath.    Boston, 

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115.  KEANE,  AUGUSTIN.    San  Francisco's  plague  war.    Review  of  Reviews, 

New  York,  November,  1908,  pp.  561-571. 

\    116.  KEEPER,  FRANK.     A  text-book  of  military  hygiene.     Philadelphia, 
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117.  KELLY,  H.  A.    Life  of  Walter  Reed.    Washington,  Office  of  Surgeon- 

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118.  KELLY,  M.  FITZMAURICE.    Amputation  in  war  surgery.    Lancet,  Lon- 

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119.  KEMSIES,  Dr.  F.     Military  preparation  of  the  youth  and  the  school. 

Zeitschrift  fur  Schulgesundheitspflege,    Leipzig,   1915,    nr.   I,  pp. 
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120.  KEYS,  C.  M.     The  battle  against  pestilence.     World's  Work,  New 

York,  1909,  v.  1 8,  pp.  11798-11804. 

121.  KIPLING,  RUDYARD.    The  new  army  in  training.     New  York,  Mac- 

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122.  KLASSEN,  LUDWIG.     Grundriss-Vorbilder  von  Gebauden  fur  milita- 

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123.  KLOSS,  ERICH.     Nourishment  in  relation  to  sickness  as  cause  and 

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124.  VON   KLUMER,   Prof.   Kriegsunterstiitzung  und   uneheliche  Kinder. 

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126.  KREUTER, — .    Tetanus.    MunchenermedizinischeWochenschrift,i^i^ 

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127.  LAGARDE,  Col.  Louis  A.     Gun-shot  injuries,  how  they  are  inflicted, 

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128.  LAQUER,  B.    War  food  and  alcohol.     Therapie  der  Gegenwart,  Berlin, 

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129.  LARNED,  C.  W.    Modern  soldiers  and  lessons  of  recent  wars.    Inter- 

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130.  LARRY,  D.  J.     Memoirs  of  military  surgery  and  campaigns  of  the 

French  armies  under  Napoleon  (translated  by  R.  W.  Hall),  Balti- 
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131.  LAURENT,  Prof.  OCTAVE.    La  Guerre  en  Bulgarie  et  en  Turquie;  Onze 

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132.  LEISHMAN,  W.  B.    Anti-typhoid  inoculation.    Lancet,  London,  1914, 

v.  2,  p.  522. 

133.  LELEAN,  Major  P.  S.    Sanitation  in  war.    London,  J.  and  E.  Churchill, 

1915,  p.  267  (has  excellent  charts,  diagrams  and  tables). 

134.  LETTERMAN,  J.     Medical  recollection  of  the  Army  of  the  Potomac. 

Washington,  Library  of  Congress,  1870-1888,  6  vols. 

135.  LINDSAY,  S.  McCuNE.    The  public  charities  of  Porto  Rico.    Annals  of 

American  Academy  of  Science,  1904,  v.  23,  pp.  503-513. 

136.  LIVERMORE,  THOMAS  L.     Numbers  and  losses  in  the  Civil  War  in 

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137.  LOCHNER,  Louis  P.    Should  there  be  military  training  in  the  public 

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138.  LYNCH,  CHARLES.    Report  from  Manchuria.  Washington,  War  Dept., 

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139.  LYSTER,  W.  J.    Sterilization  of  water  by  calcium  hypochlorite  in  the 

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140.  MACCALLEN,  Dr.  A.  F.     The  ankylostomiasis  campaign  in  Egypt. 

Lancet,  London,  1914,  v.  2,  p.  395. 

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288.  Beri-beri;  the  rice  theory  and  recent  criticism.    Lancet,  London,  1914, 

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295.  Teachers  and  cholera  in  the  Philippines.    Nation,  New  York,  1903,  pp. 

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296.  How  the  bubonic  plague  was  driven  out  of  the  Philippines.    Review  of 

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297.  Eradicating  plague  from  San  Francisco:    Report  of  the  health  com- 

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298.  Sanitary  authorities  and  epidemic  diarrhoea.    Lancet,  London,  1914, 

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299.  Dysentery.    Lancet,  London,  1914,  v.  2,  p.  765,  pp.  783-789. 

300.  Gonorrhoea  among  the  troops.    Lancet,  London,  1914,  v.  2,  pp.  1020- 

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301.  A  treatise  on  the  cause  of  heart  disease  with  chapter  on  the  reason 

for  its  prevalence  in  the  army.    Edinburgh,  1872. 

302.  Kala-azar  and  allied  conditions.    Lancet,  London,  1914,  v.  2,  p.  395. 

303.  The  present  status  of  the  leprosy  problem  in  Hawaii;  its  nature,  treat- 

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305.  The  nervous  system  in  naval  warfare.     Medical  Record,  New  York, 

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306.  The  army  and  mental  disease.     Journal  of  the  American  Medical 

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308.  Nerves  and  the  war.     The  mental  treatment  bill.     Lancet,  London, 

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309.  Shells  explosions  and  the  special  senses.    Lancet,  London,  1915,  v.  i. 

310.  Neuroses  and  war.    Lancet,  London,  1914,  v.  2,  p.  1388. 

311.  Ein  Fall  von  Wirbelschutz  mit  Verletzung  der  Cauda  equina.     Neu- 

rologisches  Centralblatt,  Leipzig,  1915,  nr.  7,  pp.  15-17. 

312.  Soldiers'  dreams.    Lancet,  London,  1915,  v.  I,  p.  210. 

313.  Cerebral  physiology  and  its  service  in  war.     Berliner  medizinische 

Wochenschrift,  April  5,  1915.     (Extract  in  Medical  Record,  New 
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314.  Wind  contusions.    Lancet,  London,  1914,  v.  I,  p.  533. 

315.  War  and  nervous  breakdown.  Lancet,  London,  1915,  v.  I,  pp.  189-190. 

316.  War  psychoses.    Medical  Record,  New  York,  March  27,  1915. 

317.  Report  on  pneumonia  in  the  Rand.    Journal  of  the  American  Medical 

Association,  1914,  pp.  1855-1865. 
TETANUS.    71,  126. 

318.  The  local  therapy  of  tetanus.    Lancet,  London,  1914,  v.  2,  pp.  955-956. 

319.  The  treatment  of  tetanus.     Lancet,  London,  1914,  v.  2,  p.  962,  p. 

963,  p.  1006,  p.  1017,  p.  1178,  p.  1370. 

320.  Krieg  und  Tuberkulose.   Wiener  klinische  Wochenschrift,  1914,  nr.  34. 
TYPHOID.   75,  132,  169,  193,  201. 

321.  Anti-typhoid  inoculation  in  war  time.    Lancet,  London,  1914,  v.  2, 

P-  55,  P-  465,  P-  632,  p.  718,  p.  818,  p.  1260. 

322.  Typhoid  immunization  and  allied  subjects.    Milnchener  medizinische 

Wochenschrift,  March  30,  1915.    (Extract  in  Medical  Record,  New 
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323.  The  vaccination  of  Porto  Rico;  a  lesson  to  the  world.    Military  Sur- 

geon, Carlisle,  1903. 

324.  General  vaccination  on  the  island.    Washington,  Military  Governor 

Porto  Rico.    App.   .      .      .  Epit.  Rep.  1899-1900,  pp.  131-133. 
VENEREAL   DISEASES.   23,  30,  50,  133,  212,  236,  300,  331. 
EUGENICS.   3,  7,  34,  50,  99,  no,  in,  112,  113,  114,  124,  164,  190,  197, 

206,  212,  233,  234,  235,  236. 

325.  The  public  service  and  the  national  crisis.    Public  Health,  Lansing, 

1914,  v.  28,  no.  2. 

326.  Eugenics  and  war.    Eugenics  Review,  London,  1914-1915,  pp.  197-203. 

327.  Marriage  'off  strength'.    Lancet,  London,  1914,  v.  2,  p.  49. 

328.  War  babies.    Lancet,  London,  1914,  v.  2,  p.  923. 

329.  The  war  babies  problem.    Nation,  New  York,  May  I,  1915. 

330.  War  brides,  illegitimacy  and  legalized  abortion.     Medical  Record, 

New  York,  May  15,  1915. 

331.  Army  statistics  and  venereal  disease.    Chicago,  Report  of  Vice  Com- 

mission of,  pp.  300-302. 
FEET.   47,  108,  116,  133,  156,  171,  187,  196,  231. 

332.  'Frost-bite'  or  'Trench-foot'.    Lancet,  London,  1915,  v.  i,  pp.  312- 

313,  p.  520. 

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HYGIENE     AND     WAR 

333.  The  care  of  the  soldiers'  feet.    Lancet,  London,  1915,  v.  i. 

334.  The  prevention  of  chafe  by  boots.    Lancet,  London,  1914,  v.  2,  p.  1018. 

335.  Treatment  of  sore  feet.    Journal  of  the  American  Medical  Association, 

Chicago,  1914,  no.  4,  p.  1216. 
FOOD.   53,  54,  55,  66,  68,  105,  116,  123,  200,  204,  210,  212,  226,  252,  262. 

336.  Nourishing  the  civil  population  on  a  war  footing.    Berliner  klinische 

Wochenschrift,  Jan.  18,  1915.  (Extract  in  Medical  Record,  New 
York,  March  6,  1915.) 

337.  Warfare  and  alimentation.     Berliner  klinische  Wochenschrift,  March 

29,  1915.    (Extract  in  Medical  Record,  New  York,  May  22,  1915.) 

338.  The  German  army  bread.    Deutsche  medizinische  Wochenschrift,  Ber- 

.lin,  April  21,    1915.      (Extract  in   Medical  Record,   New  York, 
May  22,  1915.) 

339.  Digestive  disorders  due  to  war  bread  and  their  treatment.    Berliner 

klinische  Wochenschrift,  April  5,  1915.  (Extract  in  Medical  Record, 
New  York,  May  22,  1915.) 

340.  Food  resources  in  time  of  war.    Lancet,  London,  1914,  v.  2,  p.  464. 

341.  What  to  do  with  cheap  food.    Lancet,  London,  1914,  v.  2,  p.  534. 

342.  Food  and  war.   Lancet,  London,  1914,  v.  2,  p.  511. 

343.  War  and  economy.    Lancet,  London,  1914,  v.  2,  pp.  401-402. 

344.  Protection  of  the  food  consumer.    Lancet,  London,  1914,  v.  2,  p.  755. 

345.  Soldiers'  food.    Lancet,  London,  1915,  v.  I,  p.  561,  p.  1103. 

346.  Einzelnahrung  und  Massennahrung.     Weyl's  Handbuch  der  Hygiene, 

Band  III.  Jena,  Gustav  Fischer,  1897,  pp.  90  and  109. 

347.  Leaflets  on  food.    London,  S.  W.    Whiteplace.    Board  of  Agriculture 

and  Fisheries,  1914,  price  6d.  per  volume. 

348.  Kriegsmerkblatter  (leaflets  on  such  topics  as  'War  and  youth',  'Feed- 

ing the  people',  etc.,  for  distribution  in  the  German  schools). 
Zeitschrift  fur  Schulgesundheitspflege,  Leipzig,  1915,  nr.  I,  pp. 
136-137.  Sold  by  A.  Strauss,  10  for  50  pf.;  100  for  2  M.;  1000 
for  10  M. 

349.  Manual  for  cooks.     Washington,   Army  Subsistence   Dept.,    1910. 

350.  Quick  lunch  of  the  army.    Harper's  Weekly,  New  York,  1902,  v.  46, 

p.  740. 

351.  The  treatment  of  German  prisoners.    Journal  of  the  American  Medical 

Association,  Chicago,  1914,  p.  2034. 

352.  Ration  of  war  prisoners.    Lancet,  London,  1914,  v.  2,  p.  678. 

353.  Ration  of  prisoners  in  England.     Journal  of  the  American  Medical 

Association,  Chicago,  1914,  p.  1124. 

354.  The  army  ration.    Medicine  and  hygiene  pamphlets,  New  York,  1864. 

355.  The  British  field  service  ration.     Journal  of  the  American  Medical 

Association,  Chicago,  1914,  p.  506. 

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HYGIENE     AND     WAR 

MISCELLANEOUS.    13,  51,  68,  84,  85,  131,  211,  212,  213,  214,  215,  237, 
246,  267,  268. 

356.  Military  types  of  the  United  States  Militia  and  National  Guards. 

Boston,  L.  Prang  &  Co.,  1893  (illustrated). 

357.  Relief  of  suffering  non-combatants  in  Europe.     Rockefeller  Founda- 

tion, April  22,  1915. 

358.  Kriegpadagogische  Beobachtungen.    Zeitschrift  fur  Schulgesundhe'ts- 

pflege,  Leipzig,  1915,  nr.  3,  pp.  134-136. 

359.  The  South  African  and  Russo-Japanese  Campaigns.    Lancet,  London 

1915,  v.  i,  pp.  247-248. 

360.  The  question  of  explosive  bullets.     Lancet,  London,   1914,  v.  2,  p. 

1174  (illustrated). 

361.  Regulations  for  the  duties  of  Inspector-generals  of  hospitals;  for  the 

duties  of  staff  and  regimental  officers,  etc.    London,  1859. 

362.  Tommy's  tub  and  firing  line  footlights.    Literary  Digest,  New  York, 

1915,  v.  50,  p.  1295. 

363.  Report  of  Adjutant-General.    Boston,  Massachusetts  Public  Documents 

for  1901,  v.  10. 

a.  Care  and  health  of  troops  in  hot  weather,    pp.  372-376. 

b.  Precautions  for  sanitary  protection  of  water  supply,    pp.  346-348. 

c.  Bathing  for  soldiers  with  special  reference  to  facilities  at  the  state 

camp  ground,    pp.  339-341- 

d.  Coffee  as  used  by  troops:   its  influence  and  effects,    pp.  348-351. 

e.  Effects  of  overwork,  especially  applied  to  troops,    pp.  341-344. 

f.  Outline  of  prophylaxis  and  hygiene  required  for  summer  encamp- 

ment of  volunteer  militia,    pp.  362-365. 

g.  Care  of  sinks,   pp.  309-311. 

h.  Care  of  soldiers,    pp.  357-362. 

i.    The  ordinary  ailments  of  camp  life  and   how  to  avoid   them. 

PP-  344-345- 
j.    The  proportion  of  medical  attendants  to  the  fighting  force,     pp. 

365-368. 

k.  The  medical  officer  and  his  papers,    pp.  301-304. 
1.    The  management  of  a  field  hospital,    pp.  308-309. 
m.  Sword  and  bayonet  wounds,    pp.  320-323. 
n.  First  aid  in  the  firing  line.    pp.  311,  313. 
o.  Treatment  of  gunshot  wounds,    pp.  323-327. 

p.  Knowledge  of  first  aid  required  by  officers  and  men.    pp.  315-317. 
q.  Surgery  of  future  wars.    pp.  368-372. 
364.  Armies  of  today:   a  description  of  the  leading  nations  at  the  present 

time.    New  York,  1893,  p.  438  (illustrated). 

HEALTH.   21,  25,  32,  38,  46,  86,  92,  104,  116,  133,  174,  177,  212,  241, 
243,  249,  254. 

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HYGIENE     AND     WAR 

365.  Caring  for  the  soldier's  health.      World's   Work,   New  York,    1914, 

pp.  115-119- 

366.  Health  of  the  expeditionary  force.    Lancet,  London,  1914,  v.  2,  p.  1477. 

367.  Health  of  the  Swiss  army.    Lancet,  London,  1914,  v.  2,  p.  724. 

368.  Health  in  the  armies.    Review  of  Reviews,  New  York,  1915,  pp.  526-528. 

369.  War  and  the  health  of  the  country.     Lancet,  London,   1914,  v.  2, 

pp.  709-710. 

370.  Hygiene  in  war-devastated  areas.     Lancet,  London,  1915,  v.  I,  pp. 

96-97. 

371.  Conditions  of  life  in  Paris.    Lancet,  London,  1914,  v.  2,  p.  633. 

372.  The  research  schemes  of  the  medical  committee:    influence  of  war. 

Lancet,  London,  1914,  v.  2,  p.  1915. 

373.  Side  lights  on  military  hygiene.    Lancet,  London,  1915,  v.  i,  p.  886. 

374.  The  war  and  public  hygiene  (Paris).    Journal  of  the  American  Medical 

Association,  Chicago,  1914,  p.  1217. 

375.  Hygiene  in  war.     Journal  of  the  American  Medical  Association,  Chi- 

cago, 1914,  p.  1775. 

376.  The  drug  habit  and  mobilization.    Lancet,  London,  1915,  v.  I,  p.  161. 

HISTORY.    12,  59,  80,  117,  130,  134,  141,  151,  153,  177,  191,  212,  238, 

239- 

377.  Medical  and  surgical  history  of  the  British  army  in  Crimea,  1855-1856. 

London,  1858,  2  volumes. 

378.  Medical  and  surgical  history  of  the  war  of  the  rebellion,  1861-1865. 

Washington,  v.  1-3,  medical;  v.  4-6  surgical,  1870—1888,  6  vols. 

379.  A  medical  history  of  the  war.    Lancet,  London,  1915,  v.  I,  p.  867. 

380.  The  naval,  military  and  Indian  service.    Lancet,  London,  1914,  v.  2, 

pp.  603-604. 

381.  Hygiene  and  reports  of  medical  officers  of  the  United  States  Navy. 

Washington,  1879. 

ORGANIZATION  OF  MEDICAL  CORPS,  ETC.    51,  87,  116,  122,  133, 

141,    173,  212,  222,  259. 

382.  Medical  science  in  the  service  of  war.    Scientific  American,  New  York, 

1914,  pp.  382-383. 

383.  The  medical  corps  of  the  opposing  European  Armies.    Medical  Times, 

New  York,  Oct.,  1914. 

384.  American  ambulance  in  Paris.     Science,  Lancaster,  Pa.,  n.  s.  1915, 

PP-  58-59. 

385.  Unique  American  Hospital.    Outlook,  New  York,  1914,  pp.  516-517. 

386.  Preparation  of  medical  profession  for  war.     Medical  Record,   New 

York,  May  29,  1915. 

387.  England's  Red  Cross  preparation.    Literary  Digest,  New  York,  1914, 

p.  1063. 

388.  Red  Cross  Ship.    Literary  Digest,  New  York,  1914,  pp.  512,  513. 

389.  Hospitals  in  war  time.    Lancet,  London,  1914,  v.  2,  pp.  759-761. 

[201] 


HYGIENE     AND     WAR 

390.  Medico-military  notes  from  America.     Lancet,  London,   1914,  v.  2, 

p.  1177. 

391.  The  organization  of  military  service  in  the  field.     Lancet,  London, 

1914,  v.  2,  pp.  673-675,  p.  824. 

392.  The  German  medical  profession  and  the  preparation  for  war.    Lancet, 

London,  1914,  v.  2,  p.  902. 

393.  War  and  the  German  medical  profession.    Lancet,  London,  1914,  v.  2, 

P.  1334- 

394.  The  war  and  the  standard  of  medical  education.  Lancet,  London,  1914, 

v.  2,  p.  1259. 

395.  The  war  and  the  dislocation  of  private  practice.     Lancet,  London, 

1914,  v.  2,  pp.  1001-1002. 

396.  Pamphlets  on  quarantine.    Washington,  Health  and  Marine  Service, 

Public  health  bulletins,  series  1910-1914,  nos.  34,  55,  64. 

397.  Poisoning  with  'gas  bombs'.     Munchener  medizinische  Wochenschrift, 

April  6,  1915.    (Extract  in  Medical  Record,  New  York,  March  22, 

1915.) 

398.  To  deaden  sound  in  war.    Medical  Record,  New  York,  March  13,  1915. 

RECRUITS  (training,  selection,  etc.).  3,  7,  10,  15,  16,  19,  43,  52,  67,  733, 
8oa,  91,  107,  116,  119,  121,  129,  133,  138,  145,  148,  149,  158, 
165,  177,  179,  183,  185,  199,  208,  251,  253,  259. 

399.  The  physique  of  the  recruit.  Lancet,  London,  1914,  v.  2,  pp.  658-661. 

400.  The  medical  examination  of  the  recruit.     Lancet,  London,  Sept.  12, 

1914. 

401.  Change  in  requirements.    Boston  Transcript,  July  14,  1915. 

402.  Some  points  on  the  examination  of  the  territorial  forces  and  their 

early  training.    British  Medical  Journal,  London,  1914,  v.  2,  pp. 

496-497- 

403.  Instruction  for  recruiting  officers  of  United  States  Navy.    Washington, 

War  Dept.  1907,  p.  10. 

404.  Report  of  the  Surgeon-general  of  the  United  States  Army.     Medical 

Record,  Jan.  9,  1915.     (An  excellent  editorial.) 

405.  Field  musicians'  manual  for  army,  navy,   Marine  Corps,   Revenue 

Cutter  Service  and  National  Guard.  Woburn,  Mass.,  1914,  p. 
141  (illustrated). 

406.  Officers'  training  corps  of  Great  Britain;    the  Australian  system  of 

national  defense;  the  Swiss  system;  presented  by  Mr.  Chamber- 
lain, Jan.  26,  1915.  Sixty-third  Congress,  3rd  session,  Senate 
doc.  796. 

407.  Against  the  loss  of  men  by  sinking  ships.    Lancet,  London,  1914,  v.  2, 

p.  1176. 

408.  Young  seaman's  manual  compiled  from  various  authorities  for  the  use 

of  United  States  training  ships  and  marine  schools.  Annual  report 
of  adjutant-general,  New  York,  1875,  v.  10,  p.  208. 

[202] 


HYGIENE     AND     WAR 

409.  Report  of  the  training  systems  for  the  navy  and  mercantile  marine 

of  England  and  on  the  naval  training  system  of  France,  made  to 
the  bureau  of  equipment  and  recruiting,  U.  S.  Navy  Dept., 
Forty-sixth  Congress,  2nd  session,  Senate,  ex.  doc.,  v.  3,  no.  52, 
p.  207. 

410.  Dental  aid  for  the  troops.    Lancet,  London,  v.  I,  pp.  350-351. 

411.  Dental  needs  of  the  army.    Lancet,  London,  1915,  v.  I,  p.  1053. 

412.  Teeth  of  the  wounded.    Literary  Digest,  New  York,  1915,  p.  543. 

413.  Military  preparation  of  young  France.    Fortnightly  Review,  New  York, 

1915,  PP-  938-946. 

SANITATION.  2,  17,  19,  20,  22,  28,  42,  44,  61,  62,  64,  72,  73,  79,  81,  87,  89, 
90,  97,  103,  106,  115,  116,  120,  129,  133,  135,  138,  139,  142,  146, 
147,  155,  168,  181,  189,  195,  212,  216,  230,  232,  240,  242,  257, 
258,  259. 

414.  Actual  experience  in  Japanese- Russian  War:   battle  action  of  the  in- 

fantry; impression  of  a  commander.  Washington,  Supt.  of  docu- 
ments, U.  S.  Informational  division.  Publication,  n.  s.  1906,  no.  9. 

415.  Report  of  the  Russian  medical  and  sanitary  features  of  the  Russo- 

Japanese  war  to  the  surgeon-general.  Washington,  U.  S.  Navy, 
1906,  p.  84  (with  plates). 

416.  Army  sanitation  in  Manchuria.  Scientific  American  Supplement,  1905, 

v.  60,  pp.  24675-24676. 

417.  Panama  and  sanitary  science.    Independent,  New  York,  1903,  p.  108. 

418.  Sanitation  and  the  army  medical  department.     Independent,   New 

York,  1902,  pp.  2786-2788. 

419.  Statistical  report  on  the  sickness  and  mortality  in  the  army  of  the 

U.  S.    Washington,  1840. 

420.  Statistical  report  on  the  sickness  and  mortality  in  the  army  of  the 

U.  S.  from  January  1839  to  January  1855.  Washington,  Thirty- 
fourth  Congress,  Senate,  ex.  doc.,  no.  96. 

421.  Statistics,    medical    and    anthropological    of    the    provost-marshal- 

general's  bureau.    Washington,  1875,  2  v. 

422.  Medical  results  of  war.    Literary  Digest,  New  York,  1915,  p.  74. 

423.  Cooperation  between  the  civil  and  military  service.    Lancet,  London, 

1914,  v.  2,  pp.  951-952. 

424.  Sanitation  in  Panama  as  it  relates  to  sanitation  in  the  tropics  generally. 

Transactions  of  Congress  of  American  Physicians  and  Surgeons, 
New  Haven,  1913,  pp.  45-62. 

425.  Sanitation  in  training  camps.    Journal  of  the  American  Medical  Asso- 

ciation, 1914,  p.  1867. 

426.  Military  sanitation.    Independent,  New  York,  1914,  p.  292. 

427.  Sanitary  service  in  maneuver  camps.     Military  Surgeon,   Chicago, 

August,  1914,  no.  2. 

428.  The  r61e  of  tobacco  in  war.    Lancet,  London,  1915,  v.  i,  pp.  857-858. 

[203] 


HYGIENE     AND     WAR 

429.  Army,  Pack  train,  Pack  transportation.  Washington,  Quartermaster's 

Dept.  1910  (published  for  use  in  the  army). 

430.  Commissariat.    Manual  1897.     Manual  1900.    Washington,  Quarter- 

master's Dept.  (by  D.  E.  McCarthy). 

431.  Commissariat.    Manual  for  subsistence  department  corrected  to  April 

3,  1897;  Sept.  i,  1908;  1910;  and  1898-1910.    Washington,  Quar- 
termaster's Dept. 

432.  Commissariat.  Compilation  of  laws  relating  to  Quartermaster's  Corps, 

1914.    Washington,  Quartermaster's  Dept. 

433.  Commissariat.     How  to  feed  an  army.     Washington.     Subsistence 

Dept.    Published  by  authority  of  the  Secretary  of  War  for  use  of 
the  army  of  U.  S.,  1901. 

434.  Reports,  etc.     Bulletins  i-g,  inclusive.     Washington.     Office  of  the 

Surgeon-general,  1913. 
no.  I.  Photomicrographs  of  spirochetae,  entamebae,  plasmodia,  trypan- 

osomes,  leishmanici,  negri  bodies  and  parasitic  helminths, 
no.  2.  Paper  by  officers  of  the  medical  corps, 
no.  3.  Studies  of  syphilis  by  C.  F.  Craig  and  H.  J.  Nichols. 
no.  4.  Disease  bearing  mosquitoes  of  North  and  Central  America,  the 

West  Indies  and  Philippine  Islands  by  C.  S.  Ludlow. 
no.  5.  Mental  disease  and  defect  in  U.  S.  troops  by  Edgar  King. 
no.  6.  The  prophylaxis  of  malaria  with  special  reference  to  the  mili- 
tary service  by  C.  F.  Craig, 
no.  7.  Studies  in  Roentgen-ray  diagnosis  with  special  reference  to  the 

gastro-intestinal  tract. 

no.  8.  The  prevalence  of  syphilis  in  the  army  by  E.  B.  Vedder. 
no.  9.  Gunshot  roentgenograms  by  C.  S.  Ford. 
Circulars  5-7,  inclusive, 
no.  5.  Report  of  epidemic  cholera  in  the  army  of  the  U.  S.  during  the 

year  1866. 
no.  6.  Report  of  the  extent  and  the  nature  of  the  materials  available 

for  the  preparation  of  a  medical  and  surgical  history  of  the 

Rebellion, 
no.  7.   Report  of  amputations  at  the  hip-joint  in  military  surgery. 

435.  Sanitary  Affairs.     Manual  for  the  medical  department  for  use  in  the 

army  of  the  U.  S.     Washington,  Office  of  the  Surgeon-general, 
1896,  1898-1900,  1902,  1911. 

436.  Sanitary  Commission. 

a.  Rules  for  preserving  the  health  of  the  soldier.    Washington,  1861, 

p.  1 6. 

b.  Surgical  memoirs  of  the  war  of  the  Rebellion.     New  York,  1870- 

1871,  2  v. 

437.  Disposal  of  sewage  and  garbage  in  foreign  countries.     Washington, 

Special  Consular  Reports,  v.  17,  pp.  1-221  and  pp.  261-265. 

[204] 


.  HYGIENE     AND     WAR 

438.  Charts.     Washington,  Treasury  Dept.     Public  Health  and  Marine 

Hospital  Service. 
Chart  i  Soil  pollution. 
Chart  2  Soil  pollution. 
Chart  3  Hookworms. 
Chart  4  Hookworms. 
Chart  5  Hookworms. 
Chart  6  Hookworms. 
Chart  7  Hookworms. 
Chart  8  Hookworms. 
Chart  9  Sanitary  toilets. 

439.  Reports,  etc.    Washington,  War  Dept. 

a.  Cavalry  service  regulations,  U.S.  Army.    Document  no.  461,  1914 

(experimental). 

b.  Soldier's  handbook  for  use  in  the  army  of  the  U.  S.,  1898-1913. 

c.  Drill  regulation  for  the  German  army.     Publication,  n.s.,  no.  IO, 

doc.  299.    Government  printing  office. 

d.  Drill  regulations  and  outlines  for  first  aid  for  the  hospital  corps, 

U.  S.  Army.    Office  of  Surgeon-general,  1908. 

e.  Manual  for  privates  of  the  organized  militia  of  the  U.  S.     U.  S. 

Militia  Affairs  Division,  1909. 

f.  Manual  of  bayonet  exercises,  1907. 

g.  Camps  of  instruction;   report  of  officers  of  the  U.  S.  army,  1909. 
h.  Mounted  service  school,  Ft.  Riley,  1906. 

i.    The  army  horse  in  action  and  disease,  1909. 
VERMIN.   41,  89,  116,  133,  220,  259. 

440.  Vermin  in  the  trenches.    Lancet,  London,  1915,  v.  i,  p.  416,  p.  529. 
WOUNDS  (kinds,  character,  infection,  etc.).   10,  16,  20,  26,  35,  37,  56,  63, 

65,  70,  76,  77,  78,  82,  83,  93,  101,  102,  116,  118,  125,  127,  130, 
133,  143,  159,  160,  167,  170,  172,  188,  203,  212,  218,  224,  229, 
247,  255,  256,  266. 

441.  The  care  of  the  wounded,  then  and  now.    Nineteenth  Century,  London, 

1915,  pp.  1186-1197. 

442.  Amputation  less  frequent  in  war.     Scientific  American,  New  York, 

1914,  p.  141. 

443.  The  bacterial  infection  of  projectile  wounds.    Lancet,  London,  1915, 

v.  i,  pp.  855-866. 

444.  Care  of  the  wounded  at  a  field  hospital.    Lancet,  London,  1914,  v.  2, 

pp.  1064-1065. 

445.  The  care  of  our  wounded.    Lancet,  London,  1914,  v.  2,  pp.  855-856. 

446.  The  care  of  the  German  wounded.     Lancet,  London,  1915,  v.  i,  pp. 

49-50. 

447.  The  coordinated  study  of  gunshot  fractures.     Lancet,  London,  1915, 

v.  I,  pp.  139-140. 

[205] 


HYGIENE     AND     WAR 

448.  Gunshot  wounds  of  the  head.    Lancet,  London,  1915,  v.  I,  pp.  359-362. 

449.  The  treatment  of  wounds  in  war.     Lancet,  London,  1915,  v.  I,  pp. 

43-44- 

450.  The  treatment  of  gunshot  and  shell  wounds.     Lancet,  London,  1915, 

v.  I,  pp.  850-853. 

451.  Open  air  treatment  for  wounded  soldiers.    Lancet,  London,  1914,  v.  2, 

P-  1495- 

452.  The  wounded  in  war.    Lancet,  London,  v.  2,  pp.  1024,  pp.  1101-1102. 

453.  Caring  for  the  wounded  in  war.     Review  of  Reviews,  New  York,  Jan. 

1915,  pp.  98-100. 

454.  German  foresight  in  care  of  the  wounded.     Survey,  New  York,  1915, 

PP-  347-348- 

455.  Injuries  from  aviator's  darts.     Munchener  medizinische  Wochenschrift, 

Feb.  8,  1915.     (Extract  in  Medical  Record,  New  York,  March  27, 

1915-) 

456.  Lessons  in  military  surgery  taught  by  the  war  in  Europe.     Current 

Opinion,  New  York,  March,  1915,  pp.  184-185. 

457.  Blessings  of  science  on  the  battlefield.    Scientific  American,  New  York, 

1913,  P-  477- 

458.  Surgery  and  medicine  in  war.     Nation,  New  York,  Jan.,  1915,  p.  102. 

459.  The  treatment  of  wounded.     Scientific  American  Supplement,  New 

York,  1914,  v.  24,  p.  263. 

460.  Wounded  now  and  in  the  civil  war.    Boston  Herald,  May  22,  1915. 

461.  Wound  infections.    Medical  Record,  New  York,  1915,  p.  870. 

462.  X-Ray  as  applied  to  war.    Review  of  Reviews,  New  York,  April,  1915, 

p.  482. 

463.  X-Ray  work  in  war.     Scientific  American  Supplement,  New  York, 

1915,  pp.   I20-I2I. 

464.  Use  of  the  Roentgen-ray  by  medical  department  of  the  U.  S.  army  in 

the  war  with  Spain.    Washington,  Fifty-sixth  Congress,  ist  sess., 
House  doc.  729. 


206] 


PERIODICALS  AND   OTHER  SOURCES   OF   DATA 

Annual  report,  American  National  Red  Cross,  Washington. 

Archives  fur  Schiffs-und-Tropen-Hygiene,  Leipzig. 

Archives  de  medecine  et  de  pharmacie  militaires,  Paris. 

Archives  de  medecine  navale,  Paris. 

Army  and  Navy  Journal,  New  York. 

Army  and  Navy  Register,  Washington. 

Association  medicate  Internationale  contre  la  guerre,  Paris. 

Beitrdge  zur  Kriegsgeschichte,  Berlin. 

Catalog  of  military  literature.    Office  of  Surgeon-general,  Washington. 

Deutsche   militdrdrztliche   Zeitschrift  fur   die    Sanitdtsoffiziere   der   Armee, 

Marine  und  Schutztruppen,  Berlin. 
Index  Medicus,  Washington. 
Jahresbericht  uber  die  Leistungen  und  Fortschritte  auf  dem  Gebiete  der  Hygiene 

des  Militdr-Sanitdtswesen,  Berlin.       , 
Militdrarzt,  Vienna. 
Military  Surgeon,  Washington. 
Philippine  Islands,  Dept.  of  Interior.     Bureau  of  Public  Health  Quarterly 

Report,  Manila. 

Red  Cross  Bulletin,  Washington. 
Royal  Army  Medical  Corps,  Journal  of,  London. 
Scientific  memoirs  of  the  medical  and  sanitary  departments  of  the  government 

of  India,  Calcutta,  1884. 

Society  of  tropical  medicine  and  hygiene.    Year  Book.    London. 
U.  S.  Department  of  Navy.    Bureau  of  Medicine  and  Surgery,  Washington. 
U.  S.  Isthmian  Canal  Commission  1905,  Department  of  Sanitation  Reports, 

Washington. 
U.  S.  Isthmian  Canal  Commission  1905,  Board  of  Health,  Laboratory  Bulletin, 

Washington. 
U.  S.   Treasury  Department,  Public  Health  and  Marine  Hospital  Service, 

Public  Health  Reports,  Washington. 
U.  S.  Yellow  Fever  Institute  Bulletin,  Washington. 
Zeitschrift  fur  Veterindrkunde  mit  besonderer  Beriicksichtigung  der  Hygiene 

(Veterindre  der  Armee),  Berlin. 


[207 


*Losses  of  Life  in  Modern  Wars.    Austria-Hungary;  France.    By  Gaston 

Bodart,  LL.D.       Military    Selection    and    Race    Deterioration. 

By  Vernon  Lyman  Kellogg.     Edited  by  Harald  Westergaard, 

LL.D.     Published  by  the  Clarendon  Press,  Oxford,  England. 

x-2O7~6  p.    Price,  $2.00. 
*Economic   Protectionism.     By  Josef  Grunzel.     Edited  by  Eugen  von 

Philippovich.      Published    by    the    Clarendon    Press,    Oxford, 

England,    xiii-357-6  p.    Price,  $2.90. 
*Epidemics  Resulting  from  Wars.    By  Dr.  Friedrich  Prinzing.    Edited  by 

Harald    Westergaard,    LL.D.       Published    by    the    Clarendon 

Press,  Oxford,  England.    xii~34O-6  p.     Price,  $2.50. 
The  Colonial  Tariff  Policy  of  France.    By  Dr.  Arthur  Girault     Edited  by 

Charles    Gide.      Published    by   the    Clarendon    Press,    Oxford, 

England.     viii-3O5~6  p.     Price,  $2.50. 

DIVISION  OF  INTERNATIONAL  LAW  PAMPHLET  SERIES 

No.    I    Arbitrations  and  Diplomatic  Settlements  of  the  United  States. 

vii-2i  p. 
No.    2    Limitation  of  Armament  on  the  Great  Lakes.     The  Report  of 

John  W.  Foster,  Secretary  of  State,  December  7,  1892.  vii~57  p. 
No.    3    Signatures,    Ratifications,    Adhesions    and    Reservations    to    the 

Conventions  and  Declarations  of  the  First  and  Second  Hague 

Peace  Conferences.    vii~32  p. 
No.    4   The  Hague  Conventions  of  1899  (I)  and  1907  (I)  for  the  Pacific 

Settlement  of  International  Disputes.     iv~48  p. 
No.    5   The  Hague  Conventions  of  1899  (II)  and  1907  (IV)  Respecting 

the  laws  and  Customs  of  War  on  Land,    iv-33  p. 
No.    6   The  Hague  Conventions  of   1899    (III)   and    1907    (X)   for  the 

Adaptation    to    Maritime    Warfare    of    the    Principles    of    the 

Geneva  Convention,     iv-19  p. 

No.    7   The  Hague  Declarations  of  1899  (IV,  i)  and  1907  (XIV)  Prohib- 
iting the  Discharge  of  Projectiles  and  Explosives  from  Balloons. 

iv-5  p. 
No.    8   The  Hague  Declaration  (IV,  2)  of  1899  Concerning  Asphyxiating 

Gases,     iv-2  p. 
No.    9   The  Hague  Declaration  (IV,  3)  of  1899  Concerning  Expanding 

Bullets,     iv-2  p. 
No.  10   The  Final  Acts  of  the  First  and  Second  Hague  Peace  Conferences, 

together  with  the  Draft  Convention  on  a  Judicial  Arbitration 

Court.     iv~4O  p. 
No.  II    The  Hague  Convention  (II)  of  1907  Respecting  the  Limitation  of 

the  Employment  of  Force  for  the  Recovery  of  Contract  Debts. 

iv-7  p. 
No.  12   The  Hague  Convention  (III)  of  1907  Relative  to  the  Opening  of 

Hostilities,     iv-4  p. 
No.  13    The  Hague  Convention  (V)  of  1907  Respecting  the  Rights  and 

Duties  of  Neutral  Powers  and  Persons  in  Case  of  War  on  Land. 

iv-8  p. 


No.  14  The  Hague  Convention  (VI)  of  1907  Relating  to  the  Status  of 
Enemy  Merchant  Ships  at  the  Outbreak  of  Hostilities.  iv~5  p. 

No.  15  The  Hague  Convention  (VII)  of  1907  Relating  to  the  Conversion 
of  Merchant  Ships  into  Warships.  iv~5  p. 

No.  1 6  The  Hague  Convention  (VIII)  of  1907  Relative  to  the  Laying  of 
Automatic  Submarine  Contact  Mines,  iv-6  p. 

No.  17  The  Hague  Convention  (IX)  of  1907  Concerning  Bombardment 
by  Naval  Forces  in  Time  of  War.  iv-6  p. 

No.  18  The  Hague  Convention  (XI)  of  1907  Relative  to  Certain  Restric- 
tions with  Regard  to  the  Exercise  of  the  Right  of  Capture  in 
Naval  War.  iv-6  p. 

No.  19  The  Hague  Convention  (XII)  of  1907  Relative  to  the  Creation  of 
an  International  Prize  Court.  iv-2i  p. 

No.  20  The  Hague  Convention  (XIII)  of  1907  Concerning  the  Rights 
and  Duties  of  Neutral  Powers  in  Naval  War.  iv-n  p. 

No.  21  The  Geneva  Convention  of  1906  for  the  Amelioration  of  the  Con- 
dition of  the  Wounded  in  Armies  in  the  Field,  iv-iy  p. 

No.  22    Documents  Respecting  the  Limitation  of  Armaments.     v~32  p. 

No.  23  Official  Communications  and  Speeches  Relating  to  Peace  Pro- 
posals, vi-ioo  p. 

No.  24  Documents  Relating  to  the  Controversy  over  Neutral  Rights 
between  the  United  States  and  France,  1797-1800.  vii-gi  p. 

No.  25  Opinions  of  the  Attorneys-General  and  Judgments  of  the  Supreme 
Court  and  Court  of  Claims  of  the  United  States  Relating  to  the 
Controversy  over  Neutral  Rights  between  the  United  States 
and  France,  1797-1800.  v~34O  p. 

No.  26  Opinions  of  Attorneys-General,  Decisions  of  Federal  Courts,  and 
Diplomatic  Correspondence  Respecting  the  Treaties  of  1785, 
1799  and  1828,  between  the  United  States  and  Prussia,  vi- 
I58p. 

No.  27  Official  Documents  Bearing  on  the  Armed  Neutrality  of  1780  and. 
1800.  x-295  p. 

No.  28  Extracts  from  American  and  Foreign  Works  on  International 
Law  concerning  the  Armed  Neutrality  of  1780  and  1800.  iv- 
109  p. 

BOOKS 

,*The  Hague  Conventions  and  Declarations  of  1899  and  1907,  second  edi- 
tion. Edited  by  James  Brown  Scott,  Director.  xxxiii~3O3  p. 
Price,  $2.00. 

*Las  Convenciones  y  Declaraciones  de  la  Haya  de  1899  y  1907.  Edited  by 
James  Brown  Scott,  Director.  xxxv~3Oi  p.  Price,  $2.00. 

*The  Freedom  of  the  Seas.  A  dissertation  by  Hugo  Grotius.  Translated 
with  a  revision  of  the  Latin  text  of  1633,  by  Ralph  van  Deman 
Magoffin,  Ph.D.  Edited  by  James  Brown  Scott,  Director. 
xv-83  p.  (Parallel  pp.)  Price,  $2.00. 


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